Early Outcomes Of Decentralized Care for Rifampicin-Resistant Tuberculosis in Johannesburg, South Africa: An Observational Cohort Study.

Early Outcomes Of Decentralized Care for Rifampicin-Resistant Tuberculosis in Johannesburg, South Africa: An Observational Cohort Study.

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We describe baseline characteristics, time to treatment initiation and interim patient outcomes at a decentralized, outpatient treatment site for rifampicin-resistant TB (RR-TB).Prospective observational cohort study of RR-TB patients from March 2013 until December 2014.Study subjects were followed until completion of the intensive phase of treatment (6 months), transfer out, or a final outcome (loss from treatment (LFT) or death).

214 patients with RR-TB were enrolled in the study.Xpert MTB/RIF was the diagnostic test of rifampicin resistance for 87% (n = 186), followed by direct PCR on AFB positive specimen in 14 (7%) and indirect PCR on bob the boxcutter cultured isolate in 5 (2%).Median time between sputum testing and treatment initiation was 10 days (IQR 6-21).

Interim outcomes were available in 148 patients of whom 78% (n = 115) were still on treatment, 9% (n = 13) had died, and 14% (n = 20) were LFT.Amongst 131 patients with culture positive pulmonary TB, 85 (64.9%) were culture negative at 6 months, 12 were still sputum culture positive (9.

2%) and 34 had no culture documented or contaminated culture (26%).Patients who initiated as outpatients within 1 week of sputum collection for diagnosis of RR-TB had a significantly lower incidence of LFT (IRR 0.30, 95% CI: 0.

09-0.98).HIV co-infection occurred in 178 patients (83%) with a median CD4 count 88 cells/ml3 (IQR aireloom timeless odyssey 27-218).

Access to decentralized treatment coupled with the rapid diagnosis of RR-TB has resulted in short time to treatment initiation.Despite the lack of treatment delays, early treatment outcomes remain poor with high rates of death and loss from care.