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Tuberculosis management and drug resistance in Hlabisa sub-district, KwaZulu Natal

Abstract number: P1564

Sloan D.J., Dedicoat M.J.

Background: Hlabisa sub-district, in rural KwaZulu Natal, has a population of 220,000 and is served by a 300 bed hospital linked to 15 fixed primary healthcare (PHC) clinics. HIV sero-prevalence is 40%. 3000 tuberculosis (TB) cases are notified annually. TB accounts for 33% of in-patient mortality. A review of local TB control was undertaken to identify areas of public health concern.

Methods: South African National Tuberculosis Control Guidelines (2004) were followed. Diagnosis was made on sputum microscopy, clinical features and X-Ray. New patients received standard six month therapy using rifampicin, isoniazid, pyrazinamide and ethambutol. Retreatment cases and defaulters received eight months of treatment with a different protocol including intramuscular streptomycin for the first 5 months. Community treatment outcomes from October 2004-April 2005 were recorded. 337 TB in-patients were interviewed in 2005. HIV testing was offered and details of prior TB therapy recorded. Sputum was cultured on all hospital and community retreatment cases, defaulters and smear positive patients who failed to become smear negative on standard therapy.

Results: Sputum smear positivity in TB diagnosis was low (40%). Only 37% of smear positive patients were cured. 29% were lost to follow-up before the end of therapy. Defaulting was attributed to financial/transport difficulties, lack of community treatment supporters and inadequate tracing resources. 70% of TB in-patients were HIV positive. 104 (38%) had received previous TB treatment and 28 (8%) had been treated multiple times. One or more courses of prior TB therapy was associated with an increased risk of multi-drug resistant tuberculosis (Relative Risk: 1.86 [95% Confidence Interval: 1.25–2.70]). 60% of all hospital and community patients with rifampicin/isoniazid drug resistance were also resistant to streptomycin. 2 patients had Extremely Drug Resistant (XDR) TB.

Conclusions:

1TB & HIV overwhelms district hospitals in KwaZulu Natal

2Too many patients are lost to follow-up

3Previous TB treatment is associated with the development of drug resistance

4Streptomycin may no longer be an effective second line drug in this setting

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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