Multidisciplinary management of difcult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda
| dc.contributor.author | Baruch Baluku, Joseph | |
| dc.contributor.author | Katuramu, Richard | |
| dc.contributor.author | Naloka, Joshua | |
| dc.contributor.author | Kizito, Enock | |
| dc.contributor.author | Nabwana, Martin | |
| dc.contributor.author | Bongomin, Felix | |
| dc.date.accessioned | 2023-11-25T07:14:54Z | |
| dc.date.available | 2023-11-25T07:14:54Z | |
| dc.date.issued | 2021-06-03 | |
| dc.description.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. | en_US |
| dc.description.sponsorship | East African Public Health Laboratory Networking (EAPHLN) Project, Uganda under the Ministry of Health, which was supported by the World Bank | en_US |
| dc.identifier.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. | en_US |
| dc.identifier.other | https://doi.org/10.1186/s12890-021-01597-1 | |
| dc.identifier.uri | https://hdl.handle.net/20.500.14270/358 | |
| dc.language.iso | en | en_US |
| dc.publisher | BMC Pulmonary Medicine | en_US |
| dc.subject | Consilium, | en_US |
| dc.subject | Difficult to treat, | en_US |
| dc.subject | Multidisciplinary teams, | en_US |
| dc.subject | MDR TB, | en_US |
| dc.subject | Uganda, | en_US |
| dc.subject | Outcomes | en_US |
| dc.title | Multidisciplinary management of difcult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda | en_US |
| dc.type | Article | en_US |