Implementing a Short Regimen for Multidrug-Resistant Tuberculosis in Kinshasa, Democratic Republic of Congo: A Cohort Study 2014-2017

作     者：Innocent Murhula Kashongwe Leopoldine Mbulula Fina Mawete Nicole Anshambi Nadine Maingowa Michel Kaswa Jean Marie Ntumba Kayembe Francois Bompeka Lepira Zacharie Munogolo Kashongwe Innocent Murhula Kashongwe;Leopoldine Mbulula;Fina Mawete;Nicole Anshambi;Nadine Maingowa;Michel Kaswa;Jean Marie Ntumba Kayembe;Francois Bompeka Lepira;Zacharie Munogolo Kashongwe

作者机构：Pulmonology Unit Internal Medicine Kinshasa University Hospital Kinshasa Democratic Republic of the Congo Drug Resistant Tuberculosis Unit “Centre Excellence Damien” Damian Foundation Kinshasa Democratic Republic of the Congo National Tuberculosis Program of the Democratic Republic of the Congo Kinshasa Democratic Republic of the Congo Provincial Coordination for Tuberculosis Control Kinshasa Democratic Republic of the Congo 

出 版 物：《Journal of Tuberculosis Research》 (结核病研究（英文）)

年 卷 期：2020年第8卷第3期

页      面：111-126页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：MDR-TB Short Regimen Patient Centered Card 

摘      要：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 regim