| Summary: | Introduction: Tuberculosis (TB) control is included in the eight Millennium
Development Goals, with the aim to halve the prevalence and death rate associated
with TB by 2015 compared to 1990. TB is a global public health crisis aggravated by
the emergence of multidrug-resistance (MDR) and extensively drug-resistance
(XDR). South Africa is currently ranked as the country with the third highest TB and
fifth highest MDR-TB burden in the world. Sizwe Hospital is the only specialised TB
hospital in the Gauteng Province, responsible for the management of MDR and
XDR-TB. The number of admissions has increased since 2007, poor outcomes
were reported, the treatment is expensive and patients stay for long periods in
hospital. Risk factors and MDR-TB outcomes have not been well described in South
Africa. Information on admission trends, demographic and clinical profiles as well as
treatment outcomes are lacking and is critical to evaluate and strengthen the
management of MDR and XDR-TB at Sizwe Hospital.
Aim: The aim of the study is to describe and compare the admission trends and
treatment outcomes of MDR and XDR-TB patients at Sizwe Hospital in Gauteng
Province for the period January 2008 to December 2009.
Methodology: The study design was an analytical cross-sectional study based on a
record review of all adult MDR and XDR-TB patients admitted at Sizwe Hospital.
Information was extracted from the medical records and drug-resistant registers.
Excel and Epi-info was used to record and analyse the data respectively. The
variables: admissions, demographic profile, clinical profile and treatment outcomes,
were analysed through descriptive statistics and statistical tests were used for the
comparison analysis. Logistic regression was performed to determine factors
influencing death. Ethical approval was obtained from the Human Research Ethics
Committee (Medical) of the University of the Witwatersrand.
Results: The total number of adult admissions for the period was 891 with an
increased admission over the two years. MDR-TB accounted for 95.3% (849) of the
admissions and XDR-TB for 4.7% (42). The male admissions were higher (55.8%)
than the female admissions in both years. The majority of patients were in the age group 28-32 years. The media age was 36 years and increased from 35 years to
36.5 years over the study period. Most patients (75.9%, n=676), had a previous
history of TB and a higher proportion of XDR-TB patients (95.2%, n=40) had a
history of previous TB. A high proportion of 74.9% (655) of patients were HIV
positive, with a higher proportion in females (81.5%, n=317) as compared to males
(69.5%, n=338). Culture conversion decreased from 80.8% (308) to 76.7% (391)
over the two years and was higher (79.2%, n=672) in MDR-TB compared to XDRTB
(64.3%, n=27). No statistical significance was found in the treatment outcomes
comparing HIV positive and negative patients. Low cure (2.4%) was achieved and
treatment completed decreased from 42% (160) to 13.5% (69), when comparing
2008 figures with 2009, as a result of a higher proportion (33.3%, n=170) of
patients still on treatment in 2009. Age, TB diagnosis and HIV were significantly
associated with death.
Discussion: The majority of admissions were males, between 28-32 years of age
who were MDR-TB patients for the study periods January 2008 to December 2009.
The increase in the number of admissions over the study period was not significant,
however could be due to non adherence of TB treatment. XDR-TB was significantly
(p<0.01) associated with a previous history of TB treatment and female gender with
HIV infection (p<0.0001). High culture conversion was achieved in both years as a
result of monitoring and support while in hospital. HIV infection did not influence
treatment outcomes. Low cure however was observed mostly due to the lack of
documented culture results from the clinics. The decrease in treatment success
over the two years might be due to high default rate after discharge from hospital,
increase in mortality and being still on treatment during the study period. Risk
factors associated with the high mortality were age, HIV and XDR-TB.
Conclusions: The study identified the need for a comprehensive integrated
HIV/AIDS care. Hospitalisation contributed to early success and an intervention
is needed to strengthen TB control management from prevention and early
detection to case holding and follow up to improve community care. Further
studies are necessary to identify risk factors for deaths and treatment default.
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