Multidisciplinary management of difcult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda
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Date
2021-06-03
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Pulmonary Medicine
Abstract
Background: Patients with drug resistant tuberculosis (DR-TB) with comorbidities and drug toxicities are difficult to
treat. Guidelines recommend such patients to be managed in consultation with a multidisciplinary team of experts
(the “TB consilium”) to optimise treatment regimens. We describe characteristics and treatment outcomes of DR-TB
cases presented to the national DR-TB consilium in Uganda between 2013 and 2019.
Methods: We performed a secondary analysis of data from a nation-wide retrospective cohort of DR-TB patients
with poor prognostic indicators in Uganda. Patients had a treatment outcome documented between 2013 and 2019.
Characteristics and treatment outcomes were compared between cases reviewed by the consilium with those that
were not reviewed.
Results: Of 1,122 DR-TB cases, 189 (16.8%) cases from 16 treatment sites were reviewed by the consilium, of whom
86 (45.5%) were reviewed more than once. The most frequent inquiries (N=308) from DR-TB treatment sites were
construction of a treatment regimen (38.6%) and management of side efects (24.0%) while the most frequent con silium recommendations (N=408) were a DR-TB regimen (21.7%) and “observation while on current regimen” (16.6%).
Among the cases reviewed, 152 (80.4%) were from facilities other than the national referral hospital, 113 (61.1%)
were aged≥35 years, 72 (40.9%) were unemployed, and 26 (31.0%) had defaulted antiretroviral therapy. Addition ally, 141 (90.4%) had hepatic injury, 55 (91.7%) had bilateral hearing loss, 20 (4.8%) had psychiatric symptoms and 14
(17.7%) had abnormal baseline systolic blood pressure. Resistance to second-line drugs (SLDs) was observed among
9 (4.8%) cases while 13 (6.9%) cases had previous exposure to SLDs. Bedaquiline (13.2%, n=25), clofazimine (28.6%,
n=54), high-dose isoniazid (22.8%, n=43) and linezolid (6.7%, n=13) were more frequently prescribed among
cases reviewed by the consilium than those not reviewed. Treatment success was observed among 126 (66.7%) cases
reviewed.
Conclusion: Cases reviewed by the consilium had several comorbidities, drug toxicities and a low treatment success
rate. Consilia are important “gatekeepers” for new and repurposed drugs. There is need to build capacity of lower
health facilities to construct DR-TB regimens and manage adverse effects.
Description
Keywords
Consilium,, Difficult to treat,, Multidisciplinary teams,, MDR TB,, Uganda,, Outcomes
Citation
Baluku, J. B., Katuramu, R., Naloka, J., Kizito, E., Nabwana, M., & Bongomin, F. (2021). Multidisciplinary management of difficult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda. BMC Pulmonary Medicine, 21(1), 1-8.