TY - JOUR
T1 - Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa
T2 - A case control study
AU - Hirpa, Selamawit
AU - Medhin, Girmay
AU - Girma, Belaineh
AU - Melese, Muluken
AU - Mekonen, Alemayehu
AU - Suarez, Pedro
AU - Ameni, Gobena
N1 - Funding Information:
This paper was extracted from the MSc work of the first author, which was supported by Aklilu Lemma Institute of Pathobiology at Addis Ababa University, and funded by the US Agency for International Development (USAID) through the HEAL-TB (Help Ethiopia Address the Low TB Performance) Project, cooperative agreement 663-11-000002, managed by Management Sciences for Health. The views expressed in this publication are the responsibility of authors and do not necessarily reflect the views of USAID. The six co-authors supervised the first author for one year during his MSc work. The authors acknowledge the work of Barbara K. Timmons, PhD, in editing this article.
PY - 2013
Y1 - 2013
N2 - Background: Worldwide, there were 650,000 multidrug-resistant tuberculosis (MDR-TB) cases in 2010, and in 2008 the World Health Organization estimated that 150,000 deaths occurred annually due to MDR-TB. Ethiopia is 15§ssup§th§esup§ among the 27 MDR-TB high-burden countries. This study identifies factors associated with the occurrence of MDR-TB in patients who underwent first-line TB treatment in Addis Ababa City. Methods. A case control study was conducted at St. Peter Hospital and five health centers in Addis Ababa from 1 November 2011 to February 30, 2012. Cases were MDR-TB patients who were confirmed with culture and drug-susceptibility testing and were in treatment at St. Peter Hospital during the study period. Controls were patients who were on first-line anti-TB treatment and were registered as cured or having completed treatment in the period 9 April 2009- 28 February 2010, in five health centers of Addis Ababa City. Accordingly, 134 cases and an equal number of controls were included in this study. A structured interview questionnaire was used to assess factors that could potentially be associated with the occurrence of MDR-TB. Results: Factors that were significantly associated with MDR-TB: drug side effects during first-line treatment (adjusted odds ratio (AOR): 4.5, 95% CI; 1.9 - 10.5); treatment not directly observed by a health worker (AOR = 11.7, 95% CI; 4-34.3); interruption of treatment of at least a day (AOR = 13.1, 95% CI 3.0-56.6); duration of treatment between 2 and 7 months (AOR = 14.8, 95% CI 2.3-96.4); and retreatment with the Category II regimen (P = 0.000). In the current study, HIV infection was not significantly associated with the occurrence of MDR-TB. Conclusions: Patients who were not in strict DOTS programs and did not adhere to first-line TB treatment and patients who experienced side effects during first-line treatment and Category II retreatment were at significantly increased risk of developing MDR-TB. The DOTS program should, therefore, be strengthened to increase patient adherence. Drug-susceptibility testing is also highly recommended for all Category I treatment regimen failures before those patients begin the Category II regimen.
AB - Background: Worldwide, there were 650,000 multidrug-resistant tuberculosis (MDR-TB) cases in 2010, and in 2008 the World Health Organization estimated that 150,000 deaths occurred annually due to MDR-TB. Ethiopia is 15§ssup§th§esup§ among the 27 MDR-TB high-burden countries. This study identifies factors associated with the occurrence of MDR-TB in patients who underwent first-line TB treatment in Addis Ababa City. Methods. A case control study was conducted at St. Peter Hospital and five health centers in Addis Ababa from 1 November 2011 to February 30, 2012. Cases were MDR-TB patients who were confirmed with culture and drug-susceptibility testing and were in treatment at St. Peter Hospital during the study period. Controls were patients who were on first-line anti-TB treatment and were registered as cured or having completed treatment in the period 9 April 2009- 28 February 2010, in five health centers of Addis Ababa City. Accordingly, 134 cases and an equal number of controls were included in this study. A structured interview questionnaire was used to assess factors that could potentially be associated with the occurrence of MDR-TB. Results: Factors that were significantly associated with MDR-TB: drug side effects during first-line treatment (adjusted odds ratio (AOR): 4.5, 95% CI; 1.9 - 10.5); treatment not directly observed by a health worker (AOR = 11.7, 95% CI; 4-34.3); interruption of treatment of at least a day (AOR = 13.1, 95% CI 3.0-56.6); duration of treatment between 2 and 7 months (AOR = 14.8, 95% CI 2.3-96.4); and retreatment with the Category II regimen (P = 0.000). In the current study, HIV infection was not significantly associated with the occurrence of MDR-TB. Conclusions: Patients who were not in strict DOTS programs and did not adhere to first-line TB treatment and patients who experienced side effects during first-line treatment and Category II retreatment were at significantly increased risk of developing MDR-TB. The DOTS program should, therefore, be strengthened to increase patient adherence. Drug-susceptibility testing is also highly recommended for all Category I treatment regimen failures before those patients begin the Category II regimen.
KW - Adherence to TB treatment
KW - DOTS
KW - MDR-TB
KW - TB
KW - TB treatment
KW - TB treatment failure
KW - TB treatment regimens
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U2 - 10.1186/1471-2458-13-782
DO - 10.1186/1471-2458-13-782
M3 - Article
C2 - 23981845
AN - SCOPUS:84883071144
SN - 1471-2458
VL - 13
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 782
ER -