Patients accessing drug-resistant tuberculosis treatment at a decentralized outpatient hospital clinic in Johannesburg: A prospective cohort analysis

Abstract

Objective: Describe characteristics of patients receiving drug-resistant (DR) TB treatment at a decentralized, hospital-based clinic in Johannesburg. Methods: Prospective cohort analysis of patients >18 years initiating DR-TB treatment between 1 March – 30 Sept 2013. Results: 75 DR-TB patients initiated treatment during the study period; 11 were never consented. 61 patients consented and were enrolled. Median age was 33 (IQR: 28-39); 48% male. The  HIV-co-infection  rate was 80%;  51% of whom were on ART at DR-TB initiation. Pulmonary TB accounted  for 85% of the disease. 21 (34%) were rifampicin (RIF) mono-resistant, 14 patients (23%) had multi-drug resistant (MDR) TB and 2 (3%) had extensively drug-resistant (XDR) TB; 39% patients had RIF resistance detected on Xpert MTB/RIF testing but had no confirmatory resistance tests. Xpert MTB/RIF was the most common initial diagnostic method (79%), followed by line probe assay on sputum (10%) and on culture isolates (10%). Conclusion: With the roll-out of Xpert MTB/RIF and outpatient decentralized DR-TB treatment, most patients presenting for DR-TB care at a hospital-based clinic in Johannesburg were mono-RIF resistant.

Conference: SA TB conference 2014, Durban, SA