Table 3.
Treatment outcomes and clinical course of patients with MDR-TB in KwaZulu-Natal, South Africa
| Centralised hospital |
All community- based sites |
Site 1 | Site 2 | Site 3 | Site 4 | p-value | |
|---|---|---|---|---|---|---|---|
| n=813 | n=736 | n=125 | n=148 | n=202 | n=261 | ||
| Treatment outcomes¶ | |||||||
| Cured* | 280 (34.4) | 373 (50.7) | 78 (62.4) | 81 (54.7) | 94 (46.5) | 120 (46.0) | <0.001 0.009 |
| Treatment completed¥ | 159 (19.6) | 54 (7.3) | 12 (9.6) | 8 (5.4) | 19 (9.4) | 15 (5.8) | <0.001 0.265 |
| Treatment success** | 439 (54.0) | 427 (58.0) | 90 (72.0) | 89 (60.1) | 113 (55.9) | 135 (51.7) | 0.180 0.002 |
| Died‡ | 113 (13.9) | 133 (18.1) | 17 (13.6) | 22 (14.9) | 25 (12.4) | 69 (26.4) | 0.211 <0.001 |
| Failed^ | 29 (3.6) | 49 (6.7) | 7 (5.6) | 11 (7.4) | 12 (5.9) | 19 (7.3) | <0.001 0.872 |
| Default‡‡ | 230 (28.3) | 107 (14.5) | 9 (7.2) | 20 (13.5) | 50 (24.8) | 28 (10.7) | 0.004 <0.001 |
| Transferred out^^ | 2 (0.25) | 20 (2.7) | 2 (1.6) | 6 (4.1) | 2 (1.0) | 10 (3.8) | <0.001 0.130 |
| Clinical course of treatment | |||||||
| n Median no. of days from initial sputum collection to MDR-TB therapy initiation¶¶, (IQR) |
811 92, (69-120) |
724 72, (54-97) |
125 65, (42-91) |
141 66, (50-86) |
199 70, (52-99) |
259 83, (63-107) |
<0.001 <0.001 |
| n Median duration of hospitalization (days), (IQR) |
243 144, (83-185) |
636 143, (90-179) |
91 96, (57-132) |
133 117, (83-146) |
151 180, (120-197) |
261 154, (115-175) |
0.302 <0.001 |
| Median duration of MDR- TB treatment (days), (IQR) |
589, (285-700) | 712, (270-740) | 719, (588-735) | 723, (273-753) | 700, (341-733) | 687, (176-742) | <0.001 0.062 |
| Patients who culture converted, n/total culture- positive at treatment start (%) |
511/638 (80) | 536/672 (80) | 95/111 (86) | 118/139 (85) | 140/174 (81) | 183/248 (74) | 0.983 0.017 |
| n Median no of days to culture conversion‡‡, (IQR) |
511 83 (56, 111) |
536 81 (56, 110) |
95 63 (53, 84) |
118 90 (58, 125) |
140 87 (58, 120) |
183 80 (54, 109) |
0.651 0.003 |
| n Median no of days follow up from diagnosis to treatment outcome, (IQR) |
811 688 (386, 791) |
724 771 (357, 822) |
125 761 (696, 811) |
141 787 (363, 824) |
199 764 (423, 811) |
259 771 (287, 831) |
<0.001 0.877 |
Data are number (%), unless otherwise indicated
Cured: Cure was defined as completion of treatment and >5 consecutive negative culture results in the final 12 months of treatment. A patient was still considered cured If only one positive culture was reported during this time, was clinically well, and this positive culture was followed by at least 3 consecutive negative cultures taken at least 30 days apart.
Treatment completed: Treatment completion referred to completion of therapy but without bacteriologic documentation of cure.
Treatment success: Treatment success has been defined as the percentage of patients in whom the treatment outcome was either cured or completed. That is, “% successful = no. of patients cured + no. of patients completed treatment /Total no. initiated treatment × 100”.has been defined as the percentage of patients in whom the treatment outcome was either cured or completed. That is, “% successful = no. of patients cured + no. of patients completed Rx/Total no. initiated Rx × 100.
Died: Death was defined as all-cause mortality during MDR-TB treatment.
Failed: Treatment failure was defined as having more than one positive culture in the final 12 months of therapy, or if any one of the final three cultures was positive, or if more than one drug in the treatment regimen was replaced, or if treatment was terminated due to adverse events or no clinical improvement.
Default: Default was defined as an interruption in treatment for > 2 consecutive months for any reason.
Transferred out: A patient with MDR-TB who was transferred to another reporting and recording unit a year after study-enrolment whose treatment outcome is unknown.
This definition is an adaptation of the WHO definition, as date of DST results was not routinely recorded.29
Culture conversion was defined as the interval between the treatment start date and the first of two consecutive negative sputum cultures taken at least one month apart.17