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Implementation of multidrug-resistant tuberculosis (MDR-TB) treatment in Gabon: lessons learnt from the field.

Abstract：

PURPOSE:Since May 2016, WHO recommended a 9-12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the 'Bangladesh Regimen'. However, limited data exist on the appropriateness thereof, and its implementation in low- and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO. METHODS:This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TB patients received the second-line anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily. RESULTS:Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up. CONCLUSIONS:Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.

journal_name

Infection

journal_title

Infection

authors

Ateba-Ngoa U,Edoa JR,Adegbite BR,Rossatanga EG,Madiou D,Mfoumbi A,Mevyann C,Achimi Agbo P,Mahoumbou J,Gould S,Lell B,Adegnika AA,Köhler C,Kremsner PG,Massinga-Loembe M,Alabi A,Grobusch MP

doi

10.1007/s15010-019-01314-5

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

811-816

issue

5

eissn

0300-8126

issn

1439-0973

pii

10.1007/s15010-019-01314-5

journal_volume

47

pub_type

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