Determinants of multidrug resistance among previously treated tuberculosis patients in Zimbabwe, 2014.

SETTING: Zimbabwe. OBJECTIVE: To investigate the determinants of multidrug-resistant tuberculosis (MDR-TB) among previously treated TB patients. DESIGN: A 1:3 case-control study with bivariate analysis and logistic regression. RESULTS: Risk factors for MDR-TB were history of nursing an MDR-TB patient (adjusted OR [aOR] 4.46, 95%CI 2.02-9.88), history of hospitalisation for 3 days (aOR 2.91, 95%CI 1.62-5.23) and history of foreign travel and stay outside Zimbabwe (aOR 2.68, 95%CI 1.46-4.91). Protective factors were previous successful treatment (aOR 0.05, 95%CI 0.02-0.11), history of supervision by a health worker/village health worker (aOR 0.34, 95%CI 0.19-0.60) and having been treated not more than once previously for TB (aOR 0.18, 95%CI 0.08-0.38). No association between human immunodeficiency virus (HIV) infection and MDR-TB (aOR 1.00, 95%CI 0.53-1.88) was observed. However, among HIV-infected patients, those with CD4 <200 cells/mm3 were more likely to develop MDR-TB (aOR 4.62, 95%CI 2.49-8.53). CONCLUSION: Individual, service-related, social and demographic factors interact to determine multidrug resistance among previously treated TB patients. Infection control, treatment adherence, reduction of side effects and drug susceptibility testing must be strengthened to reduce the MDR-TB burden in Zimbabwe.

Does the type of treatment supporter influence tuberculosis treatment outcomes in Zimbabwe?

Zimbabwe National Tuberculosis Guidelines advise that direct observation of anti-tuberculosis treatment (DOT) can be provided by a family member/relative as a last resort. In 2011, in Nkayi District, of 763 registered tuberculosis (TB) patients, 59 (8%) received health facility-based DOT, 392 (51%) received DOT from a trained community worker and 306 (40%) from a family member/relative. There were no differences in TB treatment outcomes between the three DOT groups, apart from a higher frequency rate of 'no reported outcomes' for those receiving family-based DOT. Family members should be trained to use a suitable DOT support package.

Les directives nationales en matière de tuberculose au Zimbabwe conseillent que l'observation directe du traitement antituberculeux (DOT) puisse être fournie par un membre de la famille ou par un autre parent, et ce en dernier ressort. En 2011, dans le District de Nkayi, 762 patients tuberculeux ont été enregistrés, parmi lesquels 59 (8%) ont reçu un DOT à partir des services de santé, 392 (51%) un DOT provenant d'un travailleur formé de la collectivité et 306 (40%) d'un membre de la famille ou d'un autre parent. Il n'y a pas eu de différences en matière de résultats du traitement de la TB entre ces trois groupes DOT, à l'exception d'une fréquence plus élevée de non-signalement des résultats chez ceux recevant un DOT par un membre de leur famille. Les membres de la famille devraient être formés à utiliser un ensemble adéquat de soutien au DOT.

Las directrices nacionales sobre la tuberculosis (TB) en Zimbabue recomiendan que, como último recurso, un miembro de la familia nuclear o extensa se pueda encargar de la observación directa del tratamiento antituberculoso (DOT). En el 2011, en el Distrito de Nkayi se registraron 763 pacientes con diagnóstico de TB, de los cuales 59 (8%) recibieron el DOT en un establecimiento de salud, 392 (51%) lo recibieron de un trabajador comunitario capacitado y 306 pacientes (40%) lo recibieron de un miembro de su familia nuclear o extensa. No se observaron diferencias en los desenlaces terapéuticos entre los tres grupos, con la excepción de una mayor frecuencia de desenlaces no comunicados en el grupo donde un familiar suministraba el tratamiento. Es preciso capacitar a los miembros de la familia sobre la utilización de un módulo apropiado de apoyo al DOT.