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...
Guardado en:
| Autores principales: | , , , , , , , , , , , , , , , , , |
|---|---|
| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Public Library of Science (PLoS)
2011
|
| Materias: | |
| Acceso en línea: | https://doaj.org/article/e999a9eaf7974235b085fd0b0a135c12 |
| Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
| id |
oai:doaj.org-article:e999a9eaf7974235b085fd0b0a135c12 |
|---|---|
| record_format |
dspace |
| spelling |
oai:doaj.org-article:e999a9eaf7974235b085fd0b0a135c122021-11-18T05:41:53ZEffectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study.1549-12771549-167610.1371/journal.pmed.1000427https://doaj.org/article/e999a9eaf7974235b085fd0b0a135c122011-03-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21423586/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<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.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 MugerwaPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 8, Iss 3, p e1000427 (2011) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Medicine R |
| spellingShingle |
Medicine R 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. |
| 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 |
| 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 |
| title |
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_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_sort |
effectiveness of the standard who recommended retreatment regimen (category ii) for tuberculosis in kampala, uganda: a prospective cohort study. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2011 |
| url |
https://doaj.org/article/e999a9eaf7974235b085fd0b0a135c12 |
| work_keys_str_mv |
AT edwardcjoneslopez effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT ireneayakaka effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT jonathanlevin effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT nancyreilly effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT francismumbowa effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT scottdrydenpeterson effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT gracenyakoojo effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT kevinfennelly effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT bethtemple effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT susannakubulwa effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT mosesljoloba effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT alphonseokwera effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT kathleendeisenach effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT ruthmcnerney effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT alisonmelliott effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT jerroldjellner effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT petergsmith effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy AT roydmugerwa effectivenessofthestandardwhorecommendedretreatmentregimencategoryiifortuberculosisinkampalaugandaaprospectivecohortstudy |
| _version_ |
1718424886888628224 |