Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: a retrospective cohort study

Anita Mesic; Waliullah H Khan; Annick Lenglet; Lutgarde Lynen; Sadiqqulah Ishaq; Ei Hnin Hnin Phyu; Htay Thet Mar; Anthony Oraegbu; Mohammad Khaled Seddiq; Hashim Khan Amirzada; Jena Fernhout; Charity Kamau; Cono Ariti; Diana Gomez; Tom Decroo

doi:10.1371/journal.pone.0237787

Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: a retrospective cohort study

Anita Mesic, Waliullah H Khan, Annick Lenglet, Lutgarde Lynen, Sadiqqulah Ishaq, Ei Hnin Hnin Phyu, Htay Thet Mar, Anthony Oraegbu, Mohammad Khaled Seddiq, Hashim Khan Amirzada, Jena Fernhout, Charity Kamau, Cono Ariti, Diana Gomez, Tom Decroo

HIV and Tuberculosis

Research output: Contribution to journal › A1: Web of Science-article › peer-review

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Abstract

INTRODUCTION: Afghanistan is affected by one of the world's longest protracted armed conflicts, frequent natural disasters, disease outbreaks and large population movements and it suffers from a high burden of tuberculosis (TB), including rifampicin-resistant TB (RR-TB). The study shows Médecins Sans Frontières' experiences with care for patients with RR-TB in Kandahar Province. We describe the uptake of RR-TB treatment, how World Health Organisation criteria for the choice between the short and an individualized regimen were implemented, and treatment outcomes.

METHODS: This is a retrospective cohort analysis of routinely collected data from RR-TB patients enrolled in care from 2016 until 2019. Descriptive analysis was performed to present characteristics of patients and treatment outcomes. Multivariable Cox analysis was performed to identify risk factors for having an unfavourable treatment outcome.

RESULTS: Out of 146 enrolled RR-TB patients, 112 (76.7%) started treatment: 41 (36.6%) and 71 (63.4%) with the short and individualized treatment regimen, respectively. Of 82 with results for fluoroquinolone susceptibility, 39 (47.6%) had fluoroquinolone-resistant TB. Seven patients with initially fluoroquinolone-resistant TB and three pregnant women started the short regimen and 18 patients eligible for the short regimen started the injectable-free individualized regimen. Overall, six-month smear and culture conversion were 98.7% and 97.1%, respectively; treatment success was 70.1%. Known initial fluoroquinolone resistance (aHR 3.77, 95%CI:1.53-9.27) but not choice of regimen predicted having an unfavourable outcome.

CONCLUSION: Even though criteria for the choice of treatment regimen were not applied strictly, we have achieved acceptable outcomes in this cohort. To expand RR-TB care, treatment regimens should fit provision at primary health care level and take patient preferences into account.

Original language	English
Article number	e0237787
Journal	PLoS ONE
Volume	15
Issue number	8
Number of pages	17
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0237787
Publication status	Published - 2020

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10.1371/journal.pone.0237787Licence: CC BY

2020ponee0237787Final published version, 900 KBLicence: CC BY

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Mesic, A., Khan, W. H., Lenglet, A., Lynen, L., Ishaq, S., Phyu, E. H. H., Mar, H. T., Oraegbu, A., Seddiq, M. K., Amirzada, H. K., Fernhout, J., Kamau, C., Ariti, C., Gomez, D., & Decroo, T. (2020). Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: a retrospective cohort study. PLoS ONE, 15(8), Article e0237787. https://doi.org/10.1371/journal.pone.0237787

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title = "Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: a retrospective cohort study",

abstract = "INTRODUCTION: Afghanistan is affected by one of the world's longest protracted armed conflicts, frequent natural disasters, disease outbreaks and large population movements and it suffers from a high burden of tuberculosis (TB), including rifampicin-resistant TB (RR-TB). The study shows M{\'e}decins Sans Fronti{\`e}res' experiences with care for patients with RR-TB in Kandahar Province. We describe the uptake of RR-TB treatment, how World Health Organisation criteria for the choice between the short and an individualized regimen were implemented, and treatment outcomes.METHODS: This is a retrospective cohort analysis of routinely collected data from RR-TB patients enrolled in care from 2016 until 2019. Descriptive analysis was performed to present characteristics of patients and treatment outcomes. Multivariable Cox analysis was performed to identify risk factors for having an unfavourable treatment outcome.RESULTS: Out of 146 enrolled RR-TB patients, 112 (76.7%) started treatment: 41 (36.6%) and 71 (63.4%) with the short and individualized treatment regimen, respectively. Of 82 with results for fluoroquinolone susceptibility, 39 (47.6%) had fluoroquinolone-resistant TB. Seven patients with initially fluoroquinolone-resistant TB and three pregnant women started the short regimen and 18 patients eligible for the short regimen started the injectable-free individualized regimen. Overall, six-month smear and culture conversion were 98.7% and 97.1%, respectively; treatment success was 70.1%. Known initial fluoroquinolone resistance (aHR 3.77, 95%CI:1.53-9.27) but not choice of regimen predicted having an unfavourable outcome.CONCLUSION: Even though criteria for the choice of treatment regimen were not applied strictly, we have achieved acceptable outcomes in this cohort. To expand RR-TB care, treatment regimens should fit provision at primary health care level and take patient preferences into account.",

author = "Anita Mesic and Khan, {Waliullah H} and Annick Lenglet and Lutgarde Lynen and Sadiqqulah Ishaq and Phyu, {Ei Hnin Hnin} and Mar, {Htay Thet} and Anthony Oraegbu and Seddiq, {Mohammad Khaled} and Amirzada, {Hashim Khan} and Jena Fernhout and Charity Kamau and Cono Ariti and Diana Gomez and Tom Decroo",

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Mesic, A, Khan, WH, Lenglet, A, Lynen, L, Ishaq, S, Phyu, EHH, Mar, HT, Oraegbu, A, Seddiq, MK, Amirzada, HK, Fernhout, J, Kamau, C, Ariti, C, Gomez, D & Decroo, T 2020, 'Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: a retrospective cohort study', PLoS ONE, vol. 15, no. 8, e0237787. https://doi.org/10.1371/journal.pone.0237787

TY - JOUR

T1 - Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: a retrospective cohort study

AU - Mesic, Anita

AU - Khan, Waliullah H

AU - Lenglet, Annick

AU - Lynen, Lutgarde

AU - Ishaq, Sadiqqulah

AU - Phyu, Ei Hnin Hnin

AU - Mar, Htay Thet

AU - Oraegbu, Anthony

AU - Seddiq, Mohammad Khaled

AU - Amirzada, Hashim Khan

AU - Fernhout, Jena

AU - Kamau, Charity

AU - Ariti, Cono

AU - Gomez, Diana

AU - Decroo, Tom

N1 - FTX; DOAJ; GOAA; (CC BY 4.0)

PY - 2020

Y1 - 2020

N2 - INTRODUCTION: Afghanistan is affected by one of the world's longest protracted armed conflicts, frequent natural disasters, disease outbreaks and large population movements and it suffers from a high burden of tuberculosis (TB), including rifampicin-resistant TB (RR-TB). The study shows Médecins Sans Frontières' experiences with care for patients with RR-TB in Kandahar Province. We describe the uptake of RR-TB treatment, how World Health Organisation criteria for the choice between the short and an individualized regimen were implemented, and treatment outcomes.METHODS: This is a retrospective cohort analysis of routinely collected data from RR-TB patients enrolled in care from 2016 until 2019. Descriptive analysis was performed to present characteristics of patients and treatment outcomes. Multivariable Cox analysis was performed to identify risk factors for having an unfavourable treatment outcome.RESULTS: Out of 146 enrolled RR-TB patients, 112 (76.7%) started treatment: 41 (36.6%) and 71 (63.4%) with the short and individualized treatment regimen, respectively. Of 82 with results for fluoroquinolone susceptibility, 39 (47.6%) had fluoroquinolone-resistant TB. Seven patients with initially fluoroquinolone-resistant TB and three pregnant women started the short regimen and 18 patients eligible for the short regimen started the injectable-free individualized regimen. Overall, six-month smear and culture conversion were 98.7% and 97.1%, respectively; treatment success was 70.1%. Known initial fluoroquinolone resistance (aHR 3.77, 95%CI:1.53-9.27) but not choice of regimen predicted having an unfavourable outcome.CONCLUSION: Even though criteria for the choice of treatment regimen were not applied strictly, we have achieved acceptable outcomes in this cohort. To expand RR-TB care, treatment regimens should fit provision at primary health care level and take patient preferences into account.

AB - INTRODUCTION: Afghanistan is affected by one of the world's longest protracted armed conflicts, frequent natural disasters, disease outbreaks and large population movements and it suffers from a high burden of tuberculosis (TB), including rifampicin-resistant TB (RR-TB). The study shows Médecins Sans Frontières' experiences with care for patients with RR-TB in Kandahar Province. We describe the uptake of RR-TB treatment, how World Health Organisation criteria for the choice between the short and an individualized regimen were implemented, and treatment outcomes.METHODS: This is a retrospective cohort analysis of routinely collected data from RR-TB patients enrolled in care from 2016 until 2019. Descriptive analysis was performed to present characteristics of patients and treatment outcomes. Multivariable Cox analysis was performed to identify risk factors for having an unfavourable treatment outcome.RESULTS: Out of 146 enrolled RR-TB patients, 112 (76.7%) started treatment: 41 (36.6%) and 71 (63.4%) with the short and individualized treatment regimen, respectively. Of 82 with results for fluoroquinolone susceptibility, 39 (47.6%) had fluoroquinolone-resistant TB. Seven patients with initially fluoroquinolone-resistant TB and three pregnant women started the short regimen and 18 patients eligible for the short regimen started the injectable-free individualized regimen. Overall, six-month smear and culture conversion were 98.7% and 97.1%, respectively; treatment success was 70.1%. Known initial fluoroquinolone resistance (aHR 3.77, 95%CI:1.53-9.27) but not choice of regimen predicted having an unfavourable outcome.CONCLUSION: Even though criteria for the choice of treatment regimen were not applied strictly, we have achieved acceptable outcomes in this cohort. To expand RR-TB care, treatment regimens should fit provision at primary health care level and take patient preferences into account.

U2 - 10.1371/journal.pone.0237787

DO - 10.1371/journal.pone.0237787

M3 - A1: Web of Science-article

C2 - 32822375

SN - 1932-6203

VL - 15

JO - PLoS ONE

JF - PLoS ONE

IS - 8

M1 - e0237787

ER -

Translating drug resistant tuberculosis treatment guidelines to reality in war-torn Kandahar, Afghanistan: a retrospective cohort study

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