TY - JOUR
T1 - Shorter regimens improved treatment outcomes of multidrug-resistant tuberculosis patients in Tanzania in 2018 cohort
AU - Mleoh, Liberate
AU - Mziray, Shabani Ramadhani
AU - Tsere, Donatus
AU - Koppelaar, Inge
AU - Mulder, Christiaan
AU - Lyakurwa, Dennis
N1 - Funding Information: The authors thank the DR-TB treatment team, the Hospital Management Teams, the national TB and Leprosy Program coordinators at regional and district levels, KNCV TB Foundations and U.S Agency for International Development (USAID) for all their commendable and sincere contributions in support of the PMDT in Tanzania. Last but not least, the authors appreciate Mr Jerod Scholten for the English language editing of this manuscript. Publisher Copyright: © 2023 John Wiley & Sons Ltd.
PY - 2023/5
Y1 - 2023/5
N2 - Objective: In 2018, shorter treatment regimens (STR) for people with drug-resistant tuberculosis (DR-TB) were introduced in Tanzania and included kanamycin, high-dose moxifloxacin, prothionamide, high-dose isoniazid, clofazimine, ethambutol and pyrazinamide. We describe treatment outcomes of people diagnosed with DR-TB in a cohort initiating treatment in 2018 in Tanzania. Methods: This was a retrospective cohort study conducted at the National Centre of Excellence and decentralised DR-TB treatment sites for the 2018 cohort followed from January 2018 to August 2020. We reviewed data from the National Tuberculosis and Leprosy Program DR-TB database to assess clinical and demographic information. The association between different DR-TB regimens and treatment outcome was assessed using logistic regression analysis. Treatment outcomes were described as treatment complete, cure, death, failure or lost to follow-up. A successful treatment outcome was assigned when the patient achieved treatment completion or cure. Results: A total of 449 people were diagnosed with DR-TB of whom 382 had final treatment outcomes: 268 (70%) cured; 36 (9%) treatment completed; 16 (4%) lost to follow-up; 62 (16%) died. There was no treatment failure. The treatment success rate was 79% (304 patients). The 2018 DR-TB treatment cohort was initiated on the following regimens: 140 (46%) received STR, 90 (30%) received the standard longer regimen (SLR), 74 (24%) received a new drug regimen. Normal nutritional status at baseline [adjusted odds ratio (aOR) = 6.57, 95% CI (3.33–12.94), p < 0.001] and the STR [aOR = 2.67, 95% CI (1.38–5.18), p = 0.004] were independently associated with successful DR-TB treatment outcome. Conclusion: The majority of DR-TB patients on STR in Tanzania achieved a better treatment outcome than on SLR. The acceptance and implementation of STR at decentralised sites promises greater treatment success. Assessing and improving nutritional status at baseline and introducing new shorter DR-TB treatment regimens may strengthen favourable treatment outcomes.
AB - Objective: In 2018, shorter treatment regimens (STR) for people with drug-resistant tuberculosis (DR-TB) were introduced in Tanzania and included kanamycin, high-dose moxifloxacin, prothionamide, high-dose isoniazid, clofazimine, ethambutol and pyrazinamide. We describe treatment outcomes of people diagnosed with DR-TB in a cohort initiating treatment in 2018 in Tanzania. Methods: This was a retrospective cohort study conducted at the National Centre of Excellence and decentralised DR-TB treatment sites for the 2018 cohort followed from January 2018 to August 2020. We reviewed data from the National Tuberculosis and Leprosy Program DR-TB database to assess clinical and demographic information. The association between different DR-TB regimens and treatment outcome was assessed using logistic regression analysis. Treatment outcomes were described as treatment complete, cure, death, failure or lost to follow-up. A successful treatment outcome was assigned when the patient achieved treatment completion or cure. Results: A total of 449 people were diagnosed with DR-TB of whom 382 had final treatment outcomes: 268 (70%) cured; 36 (9%) treatment completed; 16 (4%) lost to follow-up; 62 (16%) died. There was no treatment failure. The treatment success rate was 79% (304 patients). The 2018 DR-TB treatment cohort was initiated on the following regimens: 140 (46%) received STR, 90 (30%) received the standard longer regimen (SLR), 74 (24%) received a new drug regimen. Normal nutritional status at baseline [adjusted odds ratio (aOR) = 6.57, 95% CI (3.33–12.94), p < 0.001] and the STR [aOR = 2.67, 95% CI (1.38–5.18), p = 0.004] were independently associated with successful DR-TB treatment outcome. Conclusion: The majority of DR-TB patients on STR in Tanzania achieved a better treatment outcome than on SLR. The acceptance and implementation of STR at decentralised sites promises greater treatment success. Assessing and improving nutritional status at baseline and introducing new shorter DR-TB treatment regimens may strengthen favourable treatment outcomes.
KW - PMDT
KW - cohort
KW - treatment success
UR - http://www.scopus.com/inward/record.url?scp=85150768692&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/tmi.13867
DO - https://doi.org/10.1111/tmi.13867
M3 - Article
C2 - 36864011
SN - 1360-2276
VL - 28
SP - 357
EP - 366
JO - Tropical Medicine and International Health
JF - Tropical Medicine and International Health
IS - 5
ER -