title: Outcomes from the first multidrug-resistant tuberculosis programme in Kenya.
abstract: In March 2006, the first multidrug-resistant tuberculosis (MDR-TB) treatment programme was implemented in Kenya.
  
  
  
  To describe patients' treatment outcomes and adverse events.
  
  
  
  A retrospective case note review of patients started on MDR-TB treatment at two Médecins Sans Frontières-supported sites and the national referral hospital of Kenya was undertaken. Sites operated an ambulatory model of care. Patients were treated for a minimum of 24 months with at least 4-5 drugs for the intensive phase of treatment, including an injectable agent.
  
  
  
  Of 169 patients, 25.6% were human immunodeficiency virus (HIV) positive and 89.3% were culture-positive at baseline. Adverse events occurred in 67.4% of patients: 45.9% had nausea/vomiting, 43.9% electrolyte disturbance, 41.8% dyspepsia and 31.6% hypothyroidism. The median time to culture conversion was 2 months. Treatment outcomes were as follows: 76.6% success, 14.5% deaths, 8.3% lost to follow-up and 0.7% treatment failure. HIV-positive individuals (adjusted odds ratio [aOR] 3.51, 95% confidence interval [CI] 1.12-11.03) and women (aOR 2.73, 95%CI 1.01-7.39) had a higher risk of unfavourable outcomes, while the risk was lower in those with culture conversion at 6 months (aOR 0.11, 95%CI 0.04-0.32).
  
  
  
  In Kenya, where an ambulatory model of care is used for MDR-TB treatment, treatment success was high, despite high rates of HIV. Almost half of the patients experienced electrolyte disturbance and one third had hypothyroidism; this supports the view that systematic regular biochemical monitoring is needed in Kenya.
authors.affiliation: Epicentre, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Huerga
authors.affiliation: Epicentre, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bastard
authors.affiliation: National Leprosy and Tuberculosis Control Programme, Nairobi.
authors.forename: M
authors.initials: M
authors.lastname: Kamene
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: S
authors.initials: S
authors.lastname: Wanjala
authors.affiliation: Institute for Infection and Immunity, St George's University of London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Arnold
authors.affiliation: Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: N
authors.initials: N
authors.lastname: Oucho
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Chikwanha
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Varaine
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D059012:Lost to Follow-Up; D008297:Male; D009313:National Health Programs / Q000458:organization & administration; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents