Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: A retrospective cohort study

Autor: Htay Thet Mar, Diana Gomez, Sadiqqulah Ishaq, Anthony Oraegbu, Tom Decroo, Annick Lenglet, Cono Ariti, Charity Kamau, Waliullah H Khan, Hashim Khan Amirzada, Anita Mesic, Mohammad Khaled Seddiq, Ei Hnin Hnin Phyu, Lutgarde Lynen, Jena Fernhout
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Bacterial Diseases
Pediatrics
Maternal Health
Extensively Drug-Resistant Tuberculosis
Antitubercular Agents
Otology
Deafness
Geographical Locations
0302 clinical medicine
Medical Conditions
Pregnancy
Tuberculosis
Multidrug-Resistant
Culture conversion
Medicine and Health Sciences
030212 general & internal medicine
Hearing Disorders
Multidisciplinary
Pharmaceutics
Obstetrics and Gynecology
Treatment Outcome
Infectious Diseases
Research Design
Cohort
Medicine
Female
Rifampin
Fluoroquinolones
Research Article
Adult
medicine.medical_specialty
Tuberculosis
Asia
Adolescent
Clinical Research Design
Science
World Health Organization
Research and Analysis Methods
03 medical and health sciences
Young Adult
Pharmacotherapy
Drug Therapy
medicine
Humans
Adverse effect
Retrospective Studies
business.industry
Afghanistan
Extensively drug-resistant tuberculosis
Retrospective cohort study
medicine.disease
Tropical Diseases
Health Care
Regimen
030228 respiratory system
Otorhinolaryngology
Health Care Facilities
People and Places
Women's Health
Adverse Events
business
Zdroj: PLoS ONE, Vol 15, Iss 8, p e0237787 (2020)
PLoS ONE
ISSN: 1932-6203
Popis: IntroductionAfghanistan is affected by one of the world's longest protracted armed conflicts, frequent natural disasters, disease outbreaks and large population movements and it suffers from a high burden of tuberculosis (TB), including rifampicin-resistant TB (RR-TB). The study shows Médecins Sans Frontières' experiences with care for patients with RR-TB in Kandahar Province. We describe the uptake of RR-TB treatment, how World Health Organisation criteria for the choice between the short and an individualized regimen were implemented, and treatment outcomes.MethodsThis is a retrospective cohort analysis of routinely collected data from RR-TB patients enrolled in care from 2016 until 2019. Descriptive analysis was performed to present characteristics of patients and treatment outcomes. Multivariable Cox analysis was performed to identify risk factors for having an unfavourable treatment outcome.ResultsOut of 146 enrolled RR-TB patients, 112 (76.7%) started treatment: 41 (36.6%) and 71 (63.4%) with the short and individualized treatment regimen, respectively. Of 82 with results for fluoroquinolone susceptibility, 39 (47.6%) had fluoroquinolone-resistant TB. Seven patients with initially fluoroquinolone-resistant TB and three pregnant women started the short regimen and 18 patients eligible for the short regimen started the injectable-free individualized regimen. Overall, six-month smear and culture conversion were 98.7% and 97.1%, respectively; treatment success was 70.1%. Known initial fluoroquinolone resistance (aHR 3.77, 95%CI:1.53-9.27) but not choice of regimen predicted having an unfavourable outcome.ConclusionEven though criteria for the choice of treatment regimen were not applied strictly, we have achieved acceptable outcomes in this cohort. To expand RR-TB care, treatment regimens should fit provision at primary health care level and take patient preferences into account.
Databáze: OpenAIRE
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