title: Predictors of mortality and treatment success during treatment for rifampicin-resistant tuberculosis within the South African National TB Programme, 2009 to 2011: a cohort analysis of the national case register.
abstract: BACKGROUND
  The South African Electronic Drug-Resistant Tuberculosis Register (EDRweb) is the national database of registered drug-resistant tuberculosis (DR-TB) cases.
  
  
  METHODS
  This study was a retrospective, de-identified secondary analysis of EDRweb patients initiating treatment for rifampicin-resistant TB (January 2009 to September 2011). The relative risks of death and treatment success were estimated using modified Poisson regression with robust error estimation.
  
  
  RESULTS
  Seventeen thousand six hundred and ninety-seven cases of DR-TB were registered and met the inclusion criteria; 52.0% (n=9207) were male and the median age was 35 years (interquartile range 27-43 years). Of the 9419 cases with HIV infection (53.2%), 7157 (76.0%) were on antiretroviral therapy. Most had undergone previous TB treatment (76.5%, n=13531). Multidrug-resistant TB was the most common diagnosis, at 80.6% (n=14272). No treatment outcome was available for 6934 patients (39.2%). For patients with outcomes, 4227 (39.4%) were successfully treated, 2987 (27.8%) died, 2533 (23.7%) were lost to follow-up, and 996 (9.3%) failed. Second-line drug resistance was the strongest predictor of death during DR-TB treatment; extensively drug-resistant TB patients were more likely to have died during treatment (adjusted relative risk 2.63, 95% confidence interval 2.45-2.84).
  
  
  CONCLUSIONS
  Testing for second-line drug resistance at initiation of DR-TB treatment can identify patients most at risk of treatment failure and death and most in need of individualized treatment.
authors.affiliation: Right to Care, 5(th) floor Outspan House, 1006 Lenchen Avenue North, Centurion 0157, South Africa. Electronic address: kschnipp@gmail.com.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Schnippel
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Shearer
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Denise
authors.initials: D
authors.lastname: Evans
authors.affiliation: Right to Care, 5(th) floor Outspan House, 1006 Lenchen Avenue North, Centurion 0157, South Africa; Health Economics and Epidemiology Research Office, Department of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Berhanu
authors.affiliation: National TB Programme, South African National Department of Health, Pretoria, South Africa.
authors.forename: S'celo
authors.initials: S
authors.lastname: Dlamini
authors.affiliation: National TB Programme, South African National Department of Health, Pretoria, South Africa.
authors.forename: Norbert
authors.initials: N
authors.lastname: Ndjeka
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D012293:Rifampin
keywords: Extensively drug-resistant tuberculosis; Sub-Saharan Africa; TB/HIV co-infection