Rifampicin resistant tuberculosis in Lesotho : diagnosis, treatment initiation and outcomes

Katende, Bulemba ; Esterhuizen, Tonya ; Dippenaar, Anzaan ; Warren, Robin (2019-12)

Global Health: Epidemiology and Biostatistics

CITATION: Katende, B., Esterhuizen, T.M., Dippenaar, A. et al. 2020. Rifampicin Resistant Tuberculosis in Lesotho: Diagnosis, Treatment Initiation and Outcomes. Sci Rep 10, 1917 (2020). https://doi.org/10.1038/s41598-020-58690-4

The original publication is available at: http://www.nature.com/srep/index.html


The Lesotho guidelines for the management of drug-resistant tuberculosis (TB) recommend initiation of patients diagnosed with rifampicin resistant (RR)-TB on a standardized drug resistant regimen while awaiting confirmation of rifampicin resistant TB (RR-TB) and complete drug susceptibility test results. Review of diagnostic records between 2014 and 2016 identified 518 patients with RR-TB. Only 314 (60.6%) patients could be linked to treatment records at the Lesotho MDR hospital. The median delay in treatment initiation from the availability of Xpert MTB/RIF assay result was 12 days (IQR 7–19). Only 32% (101) of patients had a documented first-line drug resistant test. MDR-TB was detected in 56.4% of patients while 33.7% of patients had rifampicin mono-resistance. Only 7.4% of patients assessed for second-line resistance had a positive result (resistance to fluoroquinolone). Treatment success was 69.8%, death rate was 28.8%, loss to follow up was 1.0%, and 0.4% failed treatment. Death was associated with positive or unavailable sputum smear at the end of first month of treatment (Fisher exact p < 0.001) and older age (p = 0.007). Urgent attention needs to be given to link patients with RR-TB to care worldwide. The association of death rate with positive sputum smear at the end of the first month of treatment should trigger early individualization of treatment.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/106911
This item appears in the following collections: