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45 Evaluation of Drug-Resistant Tuberculosis Guidelines and Outcomes by Treatment Site in South Africa

Published online by Cambridge University Press:  03 April 2024

Charles H. Rhea
Affiliation:
Vanderbilt University
Violet Chihota
Affiliation:
The Aurum Institute, Johannesburg, South Africa
Matthew Oladimeji
Affiliation:
The Aurum Institute, Johannesburg, South Africa
Africa Peter F. Rebeiro
Affiliation:
Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA
Gustavo Amorim
Affiliation:
Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA
Nina von Knorring
Affiliation:
National Health Laboratory Service, Johannesburg, South Africa Division of Clinical Microbiology and Infectious Disease, School of Pathology, University of the Witwatersrand
Shaheed V. Omar
Affiliation:
National Institute for Communicable Diseases, Johannesburg, South Africa
Farzana Ismail
Affiliation:
National Institute for Communicable Diseases, Johannesburg, South Africa
Gavin Churchyard
Affiliation:
The Aurum Institute, Johannesburg, South Africa
Yuri van der Heijden
Affiliation:
The Aurum Institute, Johannesburg, South Africa Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA
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Abstract

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OBJECTIVES/GOALS: DR-TB care in South Africa includes decentralized treatment with shorter, all-oral regimens. Treatment guidelines direct regular clinical and laboratory evaluation to assess patient improvement. We therefore measured sputum collection frequency and follow-up time to assess fidelity to these guidelines in Gauteng Province, South Africa. METHODS/STUDY POPULATION: We included Rifampicin-resistant (RR) sputum specimens from the South African National Health Laboratory Service, which provides pathology services to 80% of the population, submitted between August 2022-September 2023. Patient data were obtained from a DR-TB registry and additional sputum specimen data were collected from follow-up laboratory worksheets. Follow-up spanned from first sputum collection date (baseline) to patient outcome date (e.g., completion, lost) or study closure date (if still on treatment). Monthly sputum submission rate was measured for those with ≥1 additional sputum submitted. We compared patient data by treatment site: at the specialized hospital vs. any other site, using Wilcoxon ranksum and χ2 tests. RESULTS/ANTICIPATED RESULTS: Baseline RR-TB specimens were available for 142 patients, of whom 28 (20%) had specimens submitted from the specialized hospital. Patients at the specialized hospital were older (median age 41 vs. 35.5 years, p=0.03), had higher baseline fluoroquinolone resistance (10% vs. 1%, p=0.01), and longer follow-up (median 5.2 vs. 3.5 months, p=0.01) compared to patients elsewhere. Further, 43 (30%) patients had ≥1 additional sputum submitted during follow-up. Among these, monthly sputum collection rates did not differ by site (0.3 vs. 0.3 sputum per month, p=0.89). We anticipate that increased sputum frequency will be associated with successful TB treatment outcomes based on preliminary findings. DISCUSSION/SIGNIFICANCE: These findings highlight ongoing challenges with routine laboratory follow-up according to DR-TB guidelines across treatment sites in South Africa. Future research is needed to determine reasons for low sputum collection rates, such as low patient adherence, variation in practice of healthcare workers, loss to follow-up, and clinical challenges.

Type
Biostatistics, Epidemiology, and Research Design
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2024. The Association for Clinical and Translational Science