TITLE:
Implementing a Short Regimen for Multidrug-Resistant Tuberculosis in Kinshasa, Democratic Republic of Congo: A Cohort Study 2014-2017
AUTHORS:
Innocent Murhula Kashongwe, Leopoldine Mbulula, Fina Mawete, Nicole Anshambi, Nadine Maingowa, Michel Kaswa, Jean Marie Ntumba Kayembe, Francois Bompeka Lepira, Zacharie Munogolo Kashongwe
KEYWORDS:
MDR-TB, Short Regimen, Patient, Centered Card
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.8 No.3,
July
17,
2020
ABSTRACT: Setting: Kinshasa,
capital of Democratic Republic of Congo, has the high rate of multidrug
resistant tuberculosis (MDR-TB) which is associated with poor treatment
outcomes until 2013. A new approach was needed. Objectives: To implement a new strategy in order to improve
treatment outcomes. Design: A
retrospective cohort study reviewing all the patients diagnosed MDR
Tuberculosis between 2014 and 2017. The study was conducted in the National
Tuberculosis Program (NTP) framework comparing the short regimen and the WHO
standard regimen. Results: From 1246
patients diagnosed RR/TB, 1073 were included in the analysis: 948 on shorter
regimen, and 125 on WHO standard regimen. The strategy was based on
patient-centered care. In the short regimen group,
62.7% were male, 61.4% were age 25 - 44 years, 52.6% had previous history of TB,
39.3% underweight, 12.5% HIV positive. The median time from diagnosis to
treatment was 19 days (0 - 163). In the long regimen group, 75% were male, 37.6% were age 14 - 44
years, 61.6% underweight, 18.4% HIV positive. The median time from diagnosis to
treatment was 19 days (0 - 114). Favorable outcomes
represented 81.9% in the short regimen group versus 72% in the long regimen group. Death and loss to follow-up were more observed
in long regimen group (27.2% versus 15.4%). Factors associated with unfavorable
outcomes in the short regimen group included sex, age ≥ 45 years, previous TB
history, HIV status, delay to begin treatment. For the long regimen, the
factors age and delay emerged, underweight and HIV were borderline. Drug
adverse events were reported respectively in 43.5% and 42.4% for short and long
regimen; with gastrointestinal disturbances, vestibular troubles, ototoxicity,
arthralgia and anemia as the most common in the 2 groups. Conclusion: The new approach improved favorable outcomes. Both
short and long regimens reached a high
level of favorable outcome compared to the previous study. The short regimen,
well supervised seems to be superior to the long regimen in term of Death rate
and loss to follow up (LTFU).