Outcome Of Multidrug-resistant Tuberculosis Research Articles

PREVALENCE, MANAGEMENT AND OUTCOME OF MULTIDRUGS RESISTANT TUBERCULOSIS : A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB), is an important obstacle to global TB control. The failure to diagnose and effectively treat MDR/RR-TB patients perpetuate ongoing MDR/RR-TB transmission in the community and can amplify the MDR/RR-TB burden. The aim: The aim of this study to show about prevalence, management and outcome of multidrug resistant tuberculosis. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Sciencedirect were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: Five publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: The success of any national program can only be ascertained by studying the outcomes of treatment regimes in patients with MDR-TB enrolled in different DOTS-plus sites of the country.

Relationship between HIV viral suppression and multidrug resistant tuberculosis treatment outcomes.

The impact of HIV viral suppression on multidrug resistant tuberculosis (MDR-TB) treatment outcomes among people with HIV (PWH) has not been clearly established. Using secondary data from a cluster-randomized clinical trial among people with MDR-TB in South Africa, we examined the effects of HIV viral suppression at MDR-TB treatment initiation and throughout treatment on MDR-TB outcomes among PWH using multinomial regression. This analysis included 1479 PWH. Viral suppression (457, 30.9%), detectable viral load (524, 35.4%), or unknown viral load (498, 33.7%) at MDR-TB treatment initiation were almost evenly distributed. Having a detectable HIV viral load at MDR-TB treatment initiation significantly increased risk of death compared to those virally suppressed (relative risk ratio [RRR] 2.12, 95% CI 1.11-4.07). Among 673 (45.5%) PWH with a known viral load at MDR-TB outcome, 194 (28.8%) maintained suppression, 267 (39.7%) became suppressed, 94 (14.0%) became detectable, and 118 (17.5%) were never suppressed. Those who became detectable (RRR 11.50, 95% CI 1.98-66.65) or were never suppressed (RRR 9.28, 95% CI 1.53-56.61) were at significantly increased risk of death (RRR 6.37, 95% CI 1.58-25.70), treatment failure (RRR 4.54, 95% CI 1.35-15.24), and loss to follow-up (RRR 7.00, 95% CI 2.83-17.31; RRR 2.97, 95% CI 1.02-8.61) compared to those who maintained viral suppression. Lack of viral suppression at MDR-TB treatment initiation and failure to achieve or maintain viral suppression during MDR-TB treatment drives differences in MDR-TB outcomes. Early intervention to support access and adherence to antiretroviral therapy among PWH should be prioritized to improve MDR-TB treatment outcomes.

Treatment outcomes of multidrug resistant tuberculosis (MDR TB) treated with bedaquiline under programmatic management of drug resistant tuberculosis at a tertiary care hospital in Punjab, India

IntroductionMDR TB is a serious global concern which is hampering TB elimination goals badly. Standardized MDR TB regimen had high default rates, more side effects and poor treatment outcomes. Bedaquiline is a newer anti-tubercular drug which has made oral regimens possible for MDR TB. We aimed to study the outcomes of MDR TB patients treated with Bdq containing regimens. Methods155 patients of MDR TB on Bdq containing regimen enrolled at GMC, Patiala under NTEP from 2017 to 2020 were enrolled retrospectively. ResultsOut of 155 patients enrolled, 82 (52.9 %) were cured, 31 (20 %) completed treatment, 18 (11.6 %) defaulted, 22 (14.2 %) died and 2 (0.12 %) failed treatment. ConclusionBdq is well tolerated with very less side effects and has better outcomes as compared to standard MDR regimens which were followed earlier.

Treatment Outcomes in Multidrug-Resistant Tuberculosis During Pregnancy.

Treatment Outcomes in Multidrug-Resistant Tuberculosis During Pregnancy.

Factors associated with treatment outcome of multidrug-resistant tuberculosis patients co-infected with human immunodeficiency virus in a Drug Resistant Tuberculosis Centre

Background: Tuberculosis is one of the major public health problem, further complicated by the relentless spread of human immunodeficiency virus (HIV). The incidence of drug resistant TB among HIV patients is now increasing. Treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients co-infected with HIV is poorly documented. Objectives: Assessed the treatment outcome of MDR-TB co-infected with HIV treated under programmatic management of drug resistant tuberculosis. Methods: The study was conducted in Department of Respiratory Medicine, Princess Krishnajammanni Tuberculosis and Chest Diseases (PK TB & CD) Hospital, Mysore Medical College and Research Institute (MMCRI), Mysore. It is a retrospective study done on patients who were admitted in DRTB center of PK TB & CD hospital, Mysore for initiation of treatment from January 2013 to December 2019. Results: Among the 63 patients studied, 26 patients (41.3%) had a favorable outcome with cure and treatment completed. 25 patients (39.7%) had an unfavorable outcome with death, 9 patients (14.3%) defaulted during the treatment and 2 patients (3.2%) had failure of therapy. Conclusion: Early recognition and treatment of HIV with ART and the clinical stage of the disease during presentation affect the treatment outcome in patients with MDR-TB. Keywords: tuberculosis; HIV; outcome; multidrug resistance; ART

Review of treatment outcome of multi-drug resistant tuberculosis

Introduction: Multidrug resistant tuberculosis (MDR TB) is essentially a man-made phenomenon and arises mainly due to inadequate treatment of drug-sensitive TB. Drug resistance is seen in 1-3% of new cases and 12% of re-treated tuberculosis. Material and Methods: We studied 291 cases of multidrug resistant tuberculosis registered at drug resistant tuberculosis (DRTB) center, Mysore. Patients were treated according to programmatic management of drug resistant tuberculosis (PMDT) guidelines by DRTB committee of the hospital. Results: Out of 291 treated cases of MDR TB, 41 were diagnosed when they were on Category I regimen of revised national tuberculosis control program. Thirty cases were treatment after lost to follow-up. Twenty-one cases were co-infected with tuberculosis and human immune deficiency virus. Conclusion: Treatment outcome was available in 275 patients. Out of which 16 cases completed treatment, 106 were cured, 55 cases stopped treatment, 84 died, treatment was stopped in 3 patients due to some reason and 11 cases were switched to extensively drug resistant tuberculosis (XDR) regimen. Our study concluded that despite adequate drugs with well-organized program the treatment outcome of MDR tuberculosis was still low. Keywords: Multidrug tuberculosis; Drug resistant tuberculosis center; Programmatic management of drug resistant tuberculosis; Extensively drug resistant tuberculosis.

Adverse treatment outcomes in multidrug resistant tuberculosis go beyond the microbe-drug interaction: Results of a multiple correspondence analysis.

Introduction: Multidrug-resistant tuberculosis treatment is effective in 50% of patients due to several factors including antibiotic susceptibility of the microorganism, adverse treatment reactions, social factors, and associated comorbidities.Objectives: In this study, we describe the demographics, clinical characteristics, and factors associated with treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients in Medellín, Colombia.Materials and methods: We conducted a retrospective analysis using data from patients diagnosed with MDR-TB attending Hospital La María in Medellín, Colombia, for treatment between 2010 and 2015. Patients were categorized as having successful (cured) or poor (failure, lost to follow-up, and death) treatment outcomes. Associations between demographic, clinical factors, laboratory results, treatment outcomes, and follow-up information were evaluated by univariate, multivariate, and multiple correspondence analyses. Results: Of the 128 patients with MDR-TB, 77 (60%) had successful outcomes. Of those with poor outcomes, 26 were lost to follow-up, 15 died, and 10 were treatment failures. Irregular treatment, the presence of comorbidities, and positive cultures after more than two months of treatment were associated with poor outcomes compared to successful ones (p<0.05 for all). The multiple correspondence analyses grouped patients who were lost to follow-up, had HIV, and drug addiction, as well as patients with treatment failure, irregular treatment, and chronic obstructive pulmonary disease.Conclusion: The recognition of factors affecting treatment is essential and was associated with treatment outcomes in this series of patients. Early identification of these factors should increase the rates of treatment success and contribute to MDR-TB control.

Systematic review of therapeutic outcomes of multidrug resistant tuberculosis and their predictors in adults receiving integrated treatment of tuberculosis and human immuno-deficiency virus in low- and middle-income countries: a study protocol

BackgroundPrograms that integrate tuberculosis (TB) and human immunodeficiency virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low- and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs.MethodsA systematic review of quantitative evidence from observational cohort studies will be performed. MEDLINE, Embase, and Global Health electronic databases will be searched for relevant studies published from March 2004 to December 2019. Two investigators will independently screen the search output, review the eligible studies, and assess the quality of the eligible studies using quality assessment tools of the National Heart Lung and Blood Institute. Random-effects meta-analysis will be used to obtain summary estimates. Heterogeneity across studies will be assessed using the I2 statistic. The confidence in the summary estimates will be rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The final review will be reported following the guidelines of the Preferred Reporting System for Systematic Reviews and Meta-analysis, presented at scientific conferences and published in a peer-reviewed journal.DiscussionThis study is expected to report the performance of integrated TB/HIV treatment programs as regards their potential to uphold successful MDR-TB treatment outcomes in LMICs. Furthermore, the review will indicate patient-related and healthcare-related factors that should be addressed to improve on survival of patients with MDR-TB/HIV co-infection in LMICs.Systematic review registrationThis review has been registered with the International Prospective Register of Systematic Reviews and the reference ID is CRD42020159745

Outcome of Multidrug Resistant Tuberculosis at a Tertiary Care Hospital, Rahim Yar Khan

Background. MDR TB is a major health problem. Proper counseling and education of DR-TB patients regarding adherence to therapy, monitoring side effects of treatment and controlling the comorbidities lead to better out come. Objective: To determine the outcome of MDR-TB at tertiary care hospital, Rahim Yar Khan. Methodology: This retrospective cohort study was carried out at Department of Pulmonology Sheikh Zayed Hospital, Rahim Yar Khan. A total of 231 patients of pulmonary MDR were included from May 2014 to December 2017 between the ages of 10 to 80 years of either sex. Extra pulmonary DR-TB, Poly drug resistant TB, XDR and patients on shorter regimen of DR –TB were excluded from the study. Treatment outcomes like cured, treatment complete, died, treatment failure and lost to follow up were defined according to WHO definitions. Data was then analyzed with SPSS version 22.0 Results: Out of 231 patients, 123 (57.1%) were males and 99 (42.9%) were females with mean age of 36.13+ 16 yrs. Regarding treatment outcome, 115 patients (49.8%) cured, 1 patient (0.4%) completed, 67 (29.0%) patients died, 5 (2.2%) patients showed treatment failure, 6 (2.6%) patients lost to follow up, 27 (11.7%) patents are still under treatment and treatment of 10 (4.3%) patients not valuated. Over all successful outcome (treatment completed and cured) was 50.2% while unsuccessful outcome (died, treatment failure, lost to follow up, painters still under treatment and treatment not evaluated) was 49.8%. Conclusion: The successful outcome was 50.2% among the pulmonary MDR-TB patients which is close to WHO target success rate i.e, 55%. Younger age groups showed significantly better outcome.

Treatment outcomes in multidrug-resistant tuberculosis according to pyrazinamide susceptibility.

BACKGROUND: Pyrazinamide (PZA) is an important anti-tuberculosis drug for multidrug-resistant tuberculosis (MDR-TB). However, PZA has recently been demoted within the hierarchy of TB drugs used for MDR-TB.METHODS: We conducted a retrospective cohort study to investigate treatment outcomes for simple MDR-TB (susceptible to both second-line injectable drugs and fluoroquinolones) according to PZA susceptibility.RESULTS: Among 216 pulmonary MDR-TB patients included in the study, 68 (31.5%) were PZA-resistant (PZA-R). The mean age was 41.8 years, and 63.4% were male. Baseline characteristics such as comorbidity, previous TB history, acid-fast bacilli (AFB) smear positivity and cavitation were similar in PZA-susceptible (PZA-S) and PZA-R patients. The number of potentially effective drugs was slightly higher among PZA-S patients than among the PZA-R (5.1 vs. 4.8, respectively; P = 0.003). PZA was more frequently used in PZA-S patients (73.0%) than in the PZA-R (14.7%), while para-aminosalicylic acid was more frequently used in PZA-R than in PZA-S patients (76.5% vs. 50.7%). The treatment success rate was similar in PZA-S (77.7%) and PZA-R (75.0%) patients. PZA resistance was not associated with treatment success in multivariate analysis.CONCLUSIONS: PZA-resistant simple MDR-TB patients had the same treatment success rate as the PZA-susceptible group even without using novel anti-TB drugs.

Predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a man-made problem when bacteria are resistant to at least two anti TB drugs (Rifampicin and Isoniazid). Currently from tuberculosis infected patients, two out of ten are developing MDR-TB and it is an emerging public health problem in Ethiopia. Despite high burden of MDR-TB in Ethiopia, the treatment outcomes and predictors related to incidence among MDR-TB patients is not studied in Oromia region, Ethiopia. Therefore, the present study assessed the predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, EthiopiaMethodFacility based retrospective cohort study was conducted at hospitals in Oromia Region. All registered MDR-TB patient charts from 2015 to 2017 were considered for the study. Data entry was done by using EPI data version 3.1 Statistical Software and data analysis was done by SPSS version 20. The descriptive statistics, frequency, median and range were employed. Bivariate and multivariate Cox proportional hazard regression analysis was used to identify predictors of time to unfavorable treatment outcomes of multidrug resistant tuberculosis. In multivariate Cox proportional hazard regression analysis, the variables with P- value less than and equal to 0.05 were considered as predictor variables for time to unfavorable treatment outcome of MDR-TB.ResultFrom the total of 415 (92.84%) complete MDR-TB charts, the overall cumulative probability of unfavorable treatment outcome at the end of the treatment (two years) was 21.21%. In multivariate Cox proportional hazard analysis initial culture result [AHR = 0.52; 95% CI: 0.29, 0.96], HIV test result [AHR = 3.76; 95% CI: 2.45, 5.78] and culture at the end of continuation phases [AHR = 0.12; 95% CI: 0.08, 0.20] were the predictors of unfavorable treatment outcome.ConclusionThe magnitude of unfavorable treatment outcome at Oromia hospitals was lower than WHO regional report of 2018. This finding demonstrated that low unfavorable treatment outcomes for MDR-TB patients can be achieved in a resource-constrained and high TB-burden setting. Whereas, Initial culture result, HIV test result and culture at the end of continuation phases were determined as predictor factors with associated unfavorable treatment outcomes. Culture positive and HIV positive MDR-TB patients need special attention at the time of treatment.

Bedaquiline and delamanid in the treatment of multidrug-resistant tuberculosis: Promising but challenging.

Improving treatment outcomes in multidrug‐resistant tuberculosis (MDR‐TB) is partly hampered by inadequate effective antitubercular agents. Development of bedaquiline and delamanid has potentially changed the treatment landscape for MDR‐TB. This review provides an update on the progress of these novel antitubercular agents. We review published studies aimed at evaluating clinical efficacy and effectiveness of bedaquiline and delamanid. Five prospective clinical studies and seven retrospective studies on bedaquiline showed that patients treated with a bedaquiline‐containing regimen had a high culture conversion rate ranging from 65 to 100% and a satisfactory treatment outcome. The combined use with linezolid might add to the effectiveness of bedaquiline. Controversies about bedaquiline resistance are discussed. Three clinical trials have reported outcomes on delamanid and showed that introducing delamanid to a background regimen improved culture conversion rate at 2 months from 29.6% to more than 40%. A higher favorable treatment rate was also observed among patients who received delamanid for more than 6 months, but about a quarter of patients defaulted in the control group. Seven retrospective studies were summarized and found a treatment benefit as well. More reliable evidence from randomized clinical trials reporting on the treatment outcomes is needed urgently to support a strong recommendation for the use of delamanid. Advances in the combined use of bedaquiline and delamanid are also reviewed, and the combination may be well tolerated but requires electrocardiograph monitoring.

Treatment outcome of multidrug-resistant tuberculosis in Japan \u2013 the first cross-sectional study of Japan tuberculosis surveillance data

BackgroundMultidrug resistant-tuberculosis (MDR-TB) is a major global health concern. Its treatment requires toxic medications, is longer and costlier than drug-susceptible TB, and often results in productivity losses and poor outcomes. In Japan, a TB middle-burden country, reports on treatment outcome of MDR-TB patients have only been institution-based. We thus sought to shed some light on the nationwide treatment status and outcome of MDR-TB patients in Japan.MethodsCharacteristics and treatment status and outcome of MDR-TB patients notified between 2011 and 2013 were evaluated using the data from the Japan TB Surveillance (JTBS) system. Since the treatment outcome from the surveillance data was not directly linked to any clinical records or drug susceptible test results, we also analyzed the treatment duration of MDR-TB cases in an attempt to validate our results.ResultsBetween 2011 and 2013, a total of 172 MDR-TB patients had been notified to the JTBS as MDR-TB. 68.6% (118/172) were males and 70.9% (122/172) were Japan-born – however, over the study period, the proportions of foreign-born, of those in the age group 15–64 years old and of new cases have increased. The overall treatment completion rate was 57.0%, however, when restricted to patients aged 64 years old and below, the rate improved to 71.6%. Treatment duration of 29.2% of those patients who had been recorded as “treatment completed” in fact fell short of the 540 days, the minimum duration as recommended by the Japanese guideline.ConclusionsIncreasing proportion of new cases, and of younger age groups among the MDR-TB patients indicate new transmissions. Better strategies for early detection and containment of MDR-TB are urgently needed. The overall treatment completion rate was 57.0% over the three-year study period. However, when restricting the result to those aged 64 years old and below, the rate improved to 71.6%, which was comparable to similarly industrialized countries. Due to the limitations of the JTBS data, a comprehensive survey of all MDR-TB patients may be necessary to provide more concrete evidence for decision-making.

Clofazimine improves clinical outcomes in multidrug-resistant tuberculosis: a randomized controlled trial

ObjectivesWe carried out a randomized multicentre study in China to investigate whether the clofazimine would improve the efficacy of the standardized regimen in patients with multidrug-resistant tuberculosis (MDR-TB). MethodsPatients with MDR-TB managed in 17 TB specialist hospitals in China between September 2009 and September 2011 were randomly assigned to the treatment groups at enrolment. In the intervention group, 100 mg clofazimine per day was added to the standardized regimen. The primary outcome was the proportion of patients with successful outcomes. ResultsFrom the 156 patients that were screened, 74 were assigned to the control group and 66 to the clofazimine group. Of the 66 cases analysed for clinical outcome in the clofazimine group, 36 patients were cured, and seven completed treatment, yielding a favourable outcome rate of 65.1%. The proportion of patients with favourable outcomes receiving the control regimen was 47.3% (35/74), which was significantly lower than that in the clofazimine group (p 0.034, relative risk 0.661, 95% CI 0.243–0.949). ConclusionsThe addition of clofazimine to the standard regimen improved the treatment of MDR-TB.

Characteristics and outcome of multidrug-resistant tuberculosis in a low-incidence area

ObjectivesTo characterize multidrug-resistant tuberculosis (MDR-TB) patients treated in a low endemic area in France and to determine risk factors for resistance. We also analyzed the efficacy and tolerability of tuberculosis (TB) treatment. MethodsBetween 2002–2013, all MDR-TB patients diagnosed in western France (hospitals belonging to the GERICCO group) were retrospectively included, with a follow-up period running until 2016. A case-control study (1:2), matched according to age, sex, and year of diagnosis, was performed to assess socio-demographic and clinical data, treatment strategies, and outcomes for the MDR-TB patients and controls treated for drug-susceptible tuberculosis during the same period. ResultsOf 134 TB patients, 44 were MDR-TB and 90 were drug-susceptible TB. Of the 44 MDR-TB patients (35 MDR and nine extensively drug-resistant [XDR]), 33 (75%) were males; the median age was 33 years; and 27 (61%) were born in Eastern Europe. Prior treatment failure was more frequently reported for XDR-TB (8/9) in Georgian patients. In multivariate analysis, risk contacts and prior TB history were associated with MDR-TB. Treatment failure was associated with MDR/XDR-TB and miliary TB. ConclusionIn western France, MDR-TB more frequently occurred in recent migrants from high-risk countries with a previous history of at-risk contact with other MDR-TB patients or previous TB treatment failure.

Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis

Little is known about the impact of comorbidities on multidrug resistant (MDR) and extensively drug resistant (XDR) tuberculosis (TB) treatment outcomes. We aimed to examine the effect of human immunodeficiency virus (HIV), diabetes, chronic kidney disease (CKD), alcohol misuse, and smoking on MDR/XDRTB treatment outcomes. We searched MEDLINE, EMBASE, Cochrane Central Registrar and Cochrane Database of Systematic Reviews as per PRISMA guidelines. Eligible studies were identified and treatment outcome data were extracted. We performed a meta-analysis to generate a pooled relative risk (RR) for unsuccessful outcome in MDR/XDRTB treatment by co-morbidity. From 2457 studies identified, 48 reported on 18,257 participants, which were included in the final analysis. Median study population was 235 (range 60–1768). Pooled RR of unsuccessful outcome was higher in people living with HIV (RR = 1.41 [95%CI: 1.15–1.73]) and in people with alcohol misuse (RR = 1.45 [95%CI: 1.21–1.74]). Outcomes were similar in people with diabetes or in people that smoked. Data was insufficient to examine outcomes in exclusive XDRTB or CKD cohorts. In this systematic review and meta-analysis, alcohol misuse and HIV were associated with higher pooled OR of an unsuccessful outcome in MDR/XDRTB treatment. Further research is required to understand the role of comorbidities in driving unsuccessful treatment outcomes.

Multidrug-resistant tuberculosis in Australia, 1998-2012.

To describe the epidemiology and outcomes of multidrug-resistant tuberculosis (MDR-TB) diagnosed in Australia between 1998 and 2012. A retrospective review was undertaken involving all patients with laboratory-confirmed MDR-TB notified in Australia between 1998 and 2012 inclusive. Demographic, clinical and laboratory features are described. Clinical outcomes were defined according to World Health Organization definitions of treatment success (cure and treatment completion), treatment failure, death, loss to follow-up (including transfer out), or not evaluated at treatment completion. A total of 244 cases of MDR-TB were diagnosed in Australia during the study period, representing 1.4% of all TB cases notified. The majority were born outside Australia, including one third in Papua New Guinea. Of those with treatment outcome data available, treatment success was demonstrated in 81%. Treatment success was positively associated with use of a second-line injectable agent. Those born in Papua New Guinea were less likely to achieve treatment success. MDR-TB is uncommon in Australia. The large number of cases born in Papua New Guinea, and the poorer outcomes in this cohort, represent challenges with cross-border management of MDR-TB in the Torres Strait. Australia has an ongoing role in the prevention and management of MDR-TB locally and in the region.

Multidrug-resistant tuberculosis in Queensland, Australia: an ongoing cross-border challenge.

To examine the epidemiology, clinical features and outcomes of MDR-TB in Queensland, with a comparison between cross-border PNG and non-cross-border patients. Retrospective case series of all MDR-TB patients in Queensland between 1 January 2000 and 31 December 2014. Ninety-six patients were diagnosed with MDR-TB in Queensland between 2000 and 2014. The majority were cross-border PNG nationals diagnosed within the Torres Straight Protected Zone (n = 73, 76%). Cross-border patients were younger (27.4 vs. 36.3 years, P = 0.02), had spent less time in Australia before diagnosis (<1 vs. 19 months, P < 0.01), had higher rates of smear positivity (67.1% vs. 40%, P = 0.04) and were less likely to have received a second-line injectable agent (45.8% vs. 71.4%, P = 0.05). Cross-border patients had significantly lower rates of treatment success than non-cross-border patients (47.9% vs. 85.7%; P < 0.01). MDR-TB cases in Queensland are largely a result of cross-border PNG nationals, with poorer outcomes seen in this cohort. Continued strengthening of the region's TB programmes, with a focus on cross-border patients, is required.

Improved Survival and Cure Rates With Concurrent Treatment for Multidrug-Resistant Tuberculosis-Human Immunodeficiency Virus Coinfection in South Africa.

Mortality in multidrug-resistant (MDR) tuberculosis-human immunodeficiency virus (HIV) coinfection has historically been high, but most studies predated the availability of antiretroviral therapy (ART). We prospectively compared survival and treatment outcomes in MDR tuberculosis-HIV-coinfected patients on ART to those in patients with MDR tuberculosis alone. This observational study enrolled culture-confirmed MDR tuberculosis patients with and without HIV in South Africa between 2011 and 2013. Participants received standardized MDR tuberculosis and HIV regimens and were followed monthly for treatment response, adverse events, and adherence. The primary outcome was survival. Among 206 participants, 150 were HIV infected, 131 (64%) were female, and the median age was 33 years (interquartile range [IQR], 26-41). Of the 191 participants with a final MDR tuberculosis outcome, 130 (73%) were cured or completed treatment, which did not differ by HIV status (P = .50). After 2 years, CD4 count increased a median of 140 cells/mm3 (P = .005), and 64% had an undetectable HIV viral load. HIV-infected and HIV-uninfected participants had high rates of survival (86% and 94%, respectively; P = .34). The strongest risk factor for mortality was having a CD4 count ≤100 cells/mm3 (adjusted hazards ratio, 15.6; 95% confidence interval, 4.4-55.6). Survival and treatment outcomes among MDR tuberculosis-HIV individuals receiving concurrent ART approached those of HIV-uninfected patients. The greatest risk of death was among HIV-infected individuals with CD4 counts ≤100 cells/mm3. These findings provide critical evidence to support concurrent treatment of MDR tuberculosis and HIV.

Outcomes of multidrug-resistant tuberculosis in Zambia: a cohort analysis.

The purpose of this study was to establish a baseline for measuring the impact of the programmatic management of drug-resistant TB program by following up on outcomes of all patients diagnosed with multidrug-resistant tuberculosis in Zambia between 2012 and 2014. A cohort study of all the MDR-TB patients diagnosed at the national TB reference laboratory from across Zambia. MDR-TB was diagnosed by culture and DST, whereas outcome data were collected in 2015 by patient record checks and home visits. The total number of patients diagnosed was 258. Of those, 110 (42.6%) patients were traceable for this study. There were 67 survivor participants (60.9%); 43 (39.1%) were deceased. Out of the 110 patients who were traced, only 71 (64.5%) were started on second-line treatment. Twenty-nine (40.8%) patients were declared cured and 16.9% were still on treatment; 8.4% had failed treatment. The survival rate was 20.2 per 100 person-years of follow-up. Taking ARVs was associated with a decreased risk of dying (hazard ratio 0.12, p=0.002). Sex, age, marital status and treatment category were not important predictors of survival in MDR-TB patients. More than half of the patients diagnosed with MDR-TB were lost to follow-up before second-line treatment was initiated.