Effectiveness of the standard WHO recommended retreatment regimen (Category II) for tuberculosis in Kampala, Uganda: A prospective cohort study

Edward C. Jones-López, Irene Ayakaka, Jonathan Levin, Nancy Reilly, Francis Mumbowa, Scott Dryden-Peterson, Grace Nyakoojo, Kevin Fennelly, Beth Temple, Susan Nakubulwa, Moses L. Joloba, Alphonse Okwera, Kathleen D. Eisenach, Ruth McNerney, Alison M. Elliott, Jerrold J. Ellner, Peter G. Smith, Roy D. Mugerwa

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Each year, 10%-20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated. Methods and Findings: From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12-33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10-5.22), HIV infection (2.16; 1.01-4.61), age (aOR for 10-year increase 1.59; 1.13-2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04-1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p

Original languageEnglish (US)
Article numbere1000427
JournalPLoS Medicine
Volume8
Issue number3
DOIs
StatePublished - Mar 2011
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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