Abstract
Introduction: The MDR programme to theWest Coast Winelands area consists of inpatient treatment centres and an outreach programme, for treatment of patients in the community.
Objective: To compare baseline demographic and culture conversion rates among patients initiating MDR-TB treatment in the community versus those initiated as inpatients.
Methods: We retrospectively reviewed clinical records at the inpatient Centre of patients diagnosed between 2000 – 2006 with a first episode of MDR-TB. Patients were included if started on a regimen with 3 or more second-line anti-TB drugs (SLD), came from this area and had a bacteriological confirmed diagnosis. Time from diagnosis to treatment initiation and from initiation to culture conversion were determined, and demographic and clinical indicators at baseline.
Results: 502 patients were diagnosed with new MDR-TB, among which 324 (64.5%) started on SLD. Median age was 34, with 105 females (32%). 145/324 (45%) started in the community vs. 179 (55%) as inpatients. Inpatients and community-based were similar in baseline age and AFB result; but inpatients were more likely to be female (40% v. 23%; p<0.01), and had lower weights (47.3kg v. 53.3kg; p<0.01). Inpatients had a longer time to treatment initiation (76 v. 64 days; p<0.01). Of 172/324(53.1%) who converted, 96 (54%) were inpatients and 76/145(52%) community-based. Days to conversion were also similar between the two groups: community 121 (IQR 61-206.5) and inpatient 105 (IQR 64.5-164).
Conclusion: Algorithms are needed for identifying patients suitable for treatment in the community.
- © 2012 ERS