Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.

<h4>Background</h4>Nigeria is faced with a high burden of Human Immunodeficiency Virus (HIV) infection and multidrug-resistant tuberculosis (MDR-TB). Treatment outcomes among MDR-TB patients registered across the globe have been poor, partly due to high loss-to-follow-up. To address this...

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Autores principales:	Olanrewaju Oladimeji, Petros Isaakidis, Olusegun J Obasanya, Osman Eltayeb, Mohammed Khogali, Rafael Van den Bergh, Ajay M V Kumar, Sven Gudmund Hinderaker, Saddiq T Abdurrahman, Lovett Lawson, Luis E Cuevas
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/40c54d1cafbd4212b2a3e4fb8d74e086
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spelling	oai:doaj.org-article:40c54d1cafbd4212b2a3e4fb8d74e0862021-11-18T08:24:02ZIntensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.1932-620310.1371/journal.pone.0094393https://doaj.org/article/40c54d1cafbd4212b2a3e4fb8d74e0862014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24722139/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Nigeria is faced with a high burden of Human Immunodeficiency Virus (HIV) infection and multidrug-resistant tuberculosis (MDR-TB). Treatment outcomes among MDR-TB patients registered across the globe have been poor, partly due to high loss-to-follow-up. To address this challenge, MDR-TB patients in Nigeria are hospitalized during the intensive-phase(IP) of treatment (first 6-8 months) and are provided with a package of care including standardized MDR-TB treatment regimen, antiretroviral therapy (ART) and cotrimoxazole prophylaxis (CPT) for HIV-infected patients, nutritional and psychosocial support. In this study, we report the end-IP treatment outcomes among them.<h4>Methods</h4>In this retrospective cohort study, we reviewed the patient records of all bacteriologically-confirmed MDR-TB patients admitted for treatment between July 2010 and October 2012.<h4>Results</h4>Of 162 patients, 105(65%) were male, median age was 34 years and 28(17%) were HIV-infected; all 28 received ART and CPT. Overall, 138(85%) were alive and culture negative at the end of IP, 24(15%) died and there was no loss-to-follow-up. Mortality was related to low CD4-counts at baseline among HIV-positive patients. The median increase in body mass index among those documented to be underweight was 2.6 kg/m2 (p<0.01) and CD4-counts improved by a median of 52 cells/microL among the HIV-infected patients (p<0.01).<h4>Conclusions</h4>End-IP treatment outcomes were exceptional compared to previously published data from international cohorts, thus confirming the usefulness of a hospitalized model of care. However, less than five percent of all estimated 3600 MDR-TB patients in Nigeria were initiated on treatment during the study period. Given the expected scale-up of MDR-TB care, the hospitalized model is challenging to sustain and the national TB programme is contemplating to move to ambulatory care. Hence, we recommend using both ambulatory and hospitalized approaches, with the latter being reserved for selected high-risk groups.Olanrewaju OladimejiPetros IsaakidisOlusegun J ObasanyaOsman EltayebMohammed KhogaliRafael Van den BerghAjay M V KumarSven Gudmund HinderakerSaddiq T AbdurrahmanLovett LawsonLuis E CuevasPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 4, p e94393 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Olanrewaju Oladimeji Petros Isaakidis Olusegun J Obasanya Osman Eltayeb Mohammed Khogali Rafael Van den Bergh Ajay M V Kumar Sven Gudmund Hinderaker Saddiq T Abdurrahman Lovett Lawson Luis E Cuevas Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.
description	<h4>Background</h4>Nigeria is faced with a high burden of Human Immunodeficiency Virus (HIV) infection and multidrug-resistant tuberculosis (MDR-TB). Treatment outcomes among MDR-TB patients registered across the globe have been poor, partly due to high loss-to-follow-up. To address this challenge, MDR-TB patients in Nigeria are hospitalized during the intensive-phase(IP) of treatment (first 6-8 months) and are provided with a package of care including standardized MDR-TB treatment regimen, antiretroviral therapy (ART) and cotrimoxazole prophylaxis (CPT) for HIV-infected patients, nutritional and psychosocial support. In this study, we report the end-IP treatment outcomes among them.<h4>Methods</h4>In this retrospective cohort study, we reviewed the patient records of all bacteriologically-confirmed MDR-TB patients admitted for treatment between July 2010 and October 2012.<h4>Results</h4>Of 162 patients, 105(65%) were male, median age was 34 years and 28(17%) were HIV-infected; all 28 received ART and CPT. Overall, 138(85%) were alive and culture negative at the end of IP, 24(15%) died and there was no loss-to-follow-up. Mortality was related to low CD4-counts at baseline among HIV-positive patients. The median increase in body mass index among those documented to be underweight was 2.6 kg/m2 (p<0.01) and CD4-counts improved by a median of 52 cells/microL among the HIV-infected patients (p<0.01).<h4>Conclusions</h4>End-IP treatment outcomes were exceptional compared to previously published data from international cohorts, thus confirming the usefulness of a hospitalized model of care. However, less than five percent of all estimated 3600 MDR-TB patients in Nigeria were initiated on treatment during the study period. Given the expected scale-up of MDR-TB care, the hospitalized model is challenging to sustain and the national TB programme is contemplating to move to ambulatory care. Hence, we recommend using both ambulatory and hospitalized approaches, with the latter being reserved for selected high-risk groups.
format	article
author	Olanrewaju Oladimeji Petros Isaakidis Olusegun J Obasanya Osman Eltayeb Mohammed Khogali Rafael Van den Bergh Ajay M V Kumar Sven Gudmund Hinderaker Saddiq T Abdurrahman Lovett Lawson Luis E Cuevas
author_facet	Olanrewaju Oladimeji Petros Isaakidis Olusegun J Obasanya Osman Eltayeb Mohammed Khogali Rafael Van den Bergh Ajay M V Kumar Sven Gudmund Hinderaker Saddiq T Abdurrahman Lovett Lawson Luis E Cuevas
author_sort	Olanrewaju Oladimeji
title	Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.
title_short	Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.
title_full	Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.
title_fullStr	Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.
title_full_unstemmed	Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.
title_sort	intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in nigeria.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/40c54d1cafbd4212b2a3e4fb8d74e086
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Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.

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