Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study.
<h4>Background</h4>Each year, 10%-20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreat...
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Public Library of Science (PLoS)
2011-03-01
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| Online Access: | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1000427&type=printable |
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| author | Edward C Jones-López Irene Ayakaka Jonathan Levin Nancy Reilly Francis Mumbowa Scott Dryden-Peterson Grace Nyakoojo Kevin Fennelly Beth Temple Susan Nakubulwa Moses L Joloba Alphonse Okwera Kathleen D Eisenach Ruth McNerney Alison M Elliott Jerrold J Ellner Peter G Smith Roy D Mugerwa |
| author_facet | Edward C Jones-López Irene Ayakaka Jonathan Levin Nancy Reilly Francis Mumbowa Scott Dryden-Peterson Grace Nyakoojo Kevin Fennelly Beth Temple Susan Nakubulwa Moses L Joloba Alphonse Okwera Kathleen D Eisenach Ruth McNerney Alison M Elliott Jerrold J Ellner Peter G Smith Roy D Mugerwa |
| author_sort | Edward C Jones-López |
| collection | DOAJ |
| description | <h4>Background</h4>Each year, 10%-20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated.<h4>Methods and findings</h4>From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12-33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10-5.22), HIV infection (2.16; 1.01-4.61), age (aOR for 10-year increase 1.59; 1.13-2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04-1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p<0.0001). Multidrug-resistant TB at enrollment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0-53.4) and HIV-uninfected (14.7; 4.1-52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≥200; 3.0-18.8) and Karnofsky score <70 (2.1; 1.1-4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1-10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0-3.5).<h4>Conclusions</h4>The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients. |
| format | Article |
| id | doaj-art-e999a9eaf7974235b085fd0b0a135c12 |
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| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2011-03-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-e999a9eaf7974235b085fd0b0a135c122025-08-20T02:34:09ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762011-03-0183e100042710.1371/journal.pmed.1000427Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study.Edward C Jones-LópezIrene AyakakaJonathan LevinNancy ReillyFrancis MumbowaScott Dryden-PetersonGrace NyakoojoKevin FennellyBeth TempleSusan NakubulwaMoses L JolobaAlphonse OkweraKathleen D EisenachRuth McNerneyAlison M ElliottJerrold J EllnerPeter G SmithRoy D Mugerwa<h4>Background</h4>Each year, 10%-20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated.<h4>Methods and findings</h4>From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12-33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10-5.22), HIV infection (2.16; 1.01-4.61), age (aOR for 10-year increase 1.59; 1.13-2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04-1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p<0.0001). Multidrug-resistant TB at enrollment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0-53.4) and HIV-uninfected (14.7; 4.1-52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≥200; 3.0-18.8) and Karnofsky score <70 (2.1; 1.1-4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1-10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0-3.5).<h4>Conclusions</h4>The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients.https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1000427&type=printable |
| spellingShingle | Edward C Jones-López Irene Ayakaka Jonathan Levin Nancy Reilly Francis Mumbowa Scott Dryden-Peterson Grace Nyakoojo Kevin Fennelly Beth Temple Susan Nakubulwa Moses L Joloba Alphonse Okwera Kathleen D Eisenach Ruth McNerney Alison M Elliott Jerrold J Ellner Peter G Smith Roy D Mugerwa Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study. PLoS Medicine |
| title | Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study. |
| title_full | Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study. |
| title_fullStr | Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study. |
| title_full_unstemmed | Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study. |
| title_short | Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study. |
| title_sort | effectiveness of the standard who recommended retreatment regimen category ii for tuberculosis in kampala uganda a prospective cohort study |
| url | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1000427&type=printable |
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