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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

More than half of the patients diagnosed with MDR-TB were lost to follow-up before second-line treatment was initiated.

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Acknowledgements

The authors wish to acknowledge the field staff and collaborators who assisted with data collection; follow-up of participants and overall study implementation.

Author information

Authors and Affiliations

  1. Department of Disease Surveillance, Control and Research, Ministry of Health, Ndeke House, P. O. Box 30205, Lusaka, Zambia

    Nathan Kapata, Pascalina Chanda-Kapata, William Ngosa & Peter Mwaba

  2. Centre of Tropical Medicine and Travel Medicine, Division of Internal Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Nathan Kapata, Martin P. Grobusch & Pascalina Chanda-Kapata

  3. Department of Epidemiology and Statistics, School of Public Health, University of Zambia, Lusaka, Zambia

    Gershom Chongwe

  4. Tropical Diseases Research Centre, Ndola, Zambia

    Gershom Chongwe & Mathias Tembo

  5. National TB Reference Laboratory, Lusaka, Zambia

    Shebba Musonda

  6. University Teaching Hospital, Lusaka, Zambia

    Patrick Katemangwe

  7. HerpeZ, University Teaching Hospital, Lusaka, Zambia

    Matthew Bates

  8. Division of Infection and Immunity, Department of Infection, University College London, London, UK

    Alimuddin Zumla

  9. Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands

    Frank Cobelens

  10. Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Frank Cobelens

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  1. Nathan Kapata
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  2. Martin P. Grobusch
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  3. Gershom Chongwe
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  4. Pascalina Chanda-Kapata
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  9. Matthew Bates
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  11. Alimuddin Zumla
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  12. Frank Cobelens
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Contributions

Author contributions

Conceptualization: NK, GC, PCK, AZ. Methodology: NK, GC, FC, WN. Data analysis: PCK, MB, MPG, PK, PM. Writing original draft: NK, FC, MPG, MT, SM, PCK. Writing review and editing: NK, MPG, FC, PM, AZ.

Corresponding author

Correspondence to Nathan Kapata.

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Funding

The study was partially funded by the Government of the Republic of Zambia through the Ministry of Health, research unit.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Kapata, N., Grobusch, M.P., Chongwe, G. et al. Outcomes of multidrug-resistant tuberculosis in Zambia: a cohort analysis. Infection 45, 831–839 (2017). https://doi.org/10.1007/s15010-017-1054-8

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  • DOI: https://doi.org/10.1007/s15010-017-1054-8

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