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Journal Article > Research

Community-based treatment of drug-resistant tuberculosis in Khayelitsha, South Africa

Cox HS, Hughes J, Daniels J, Azevedo VD, McDermid C, Poolman M, Boulle AM, Goemaere E, van Cutsem G
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Abstract
SETTING: Khayelitsha, South Africa, a peri-urban township with high burdens of tuberculosis (TB), drug-resistant tuberculosis (DR-TB), and human immunodeficiency virus (HIV) infection.

OBJECTIVE: To describe case detection and patient outcomes in a community-based DR-TB programme.

DESIGN: DR-TB management was integrated into primary health care in Khayelitsha from 2007 onwards. Implementation was incremental, and included training and clinician support, counselling and home visits, tuberculous infection control, a local in-patient service, and routine monitoring. Patients received treatment rapidly through their local clinic, and were only hospitalised if clinically unwell.

RESULTS: DR-TB case notification (any rifampicin resistance) increased from 28 per 100 000 population per year (2005–2007) to 55/100 000/year in 2009–2011 (72% HIV-infected). From 2008 to 2011, 754 patients received treatment (86% of those diagnosed). The median time between diagnostic sputum and treatment decreased over the years of implementation to 27 days in 2011 (P < 0.001). Treatment success was 52% in 2010, with 31% default, 13% death and 4% treatment failure. Two-year survival was 65%, with poorer survival in those with HIV (HR 2.0, 95%CI 1.4–2.8), second-line drug resistance (HR 3.3, 95%CI 2.2–4.8), and diagnosis in earlier programme years (HR 1.4, 95%CI 1.1–2.0).

CONCLUSION: Community-based DR-TB management is feasible, and contributes to improved case detection, reduced treatment delay and improved survival. Treatment outcomes remain poor, highlighting the poor efficacy, tolerability and lengthy duration of current treatment.
Countries
South Africa
Subject Area
antibiotic resistancetuberculosisantimicrobial resistance
DOI
10.5588/ijtld.13.0742
Published Date
01-Apr-2014
PubMed ID
24670700
Languages
English
Journal
International Journal of Tuberculosis and Lung Disease
Volume / Issue / Pages
Volume 18, Issue 4, Pages 441-448
Issue Date
01-Apr-2014
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