Drug Resistant TB
This is a form of TB in which first-line anti-TB drugs have little or no effect against M. tuberculosis. The diagnosis is confirmed through molecular tests and culture and DST of M. tuberculosis strains. Four different categories of drug resistance have been identified:
• Mono resistant TB: Resistance to any single first-line anti-TB drug.
• Poly resistant TB: Resistance to more than one first-line anti-TB drug, excluding the combined resistance to both isoniazid and rifampicin.
• MDR TB: Resistance to at least both isoniazid and rifampicin.
• XDR TB: This is multidrug resistance, with additional resistance to any fluoroquinolones (ofloxacin, levofloxacin, moxifloxacin) and at least one of the three injectable drugs (amikacin, kanamycin, capreomycin).
In 2016 a total of 196 MDRTB cases were notified country wide among which 158 (82%) were started on MDR TB treatment from 21 regions. The enrollment is an increment of 28% compared to that of 2015. As in previous years, the majority of MDR TB cases detected and enrolled on treatment were from Dar es salaam (41%) followed by Mbeya (9%), Geita (7%), Mtwara (6%), Morogoro (5%) and Simiyu (5%). The graph below shows number of MDR/RR-TB patients started second line treatment in 2016
Overall, there is improvement in enrollment as compared to last year with an increase of 35 cases. This could be due to the kick off of the decentralization of the services to other facilities. This is implemented guided by the Decentralization plan (2015) of which by Dec 2016 a total of 22 sites2 had already begin offering initiation of the MDRTB treatment Among the enrolled patients, a male predominance continued to be observed with 88 (71%) being male. As in the previous year, the age groups bearing the brunt of MDR TB among, was the younger, economically active age group from 25 – 44.
End of Treatment Outcomes for 2014 Cohort:
A total of 143 patients were enrolled in 2014, with age of enrolled cases ranged from 2 to 84 years old with a median age of 39 years old. Those aged from 15 – 35 yrs were the most affected with MDR TB disease. Among MDR patients 38% (35) were HIV co-infected, while 62% (57) were HIV negative.
Of all enrolled 143 patients 108 (76%) were successfully treated (cured + treatment completed). Those with unfavorable outcome include; 25 (17%) patients died, 10(7%) patients defaulted and 2 (1%) were not evaluated. A review of trends of treatment outcomes from 2009 (figure 11) showed the treatment success rate to have dropped in 2013 with the most contributory factor being a spike in mortality. Further review of the mortality data revealed that most deaths occurred at older and younger groups, in more males than females and patients who had been in treatment for less than 6 months. HIV status was not a significant contributor as most deaths occur among the HIV negatives 14 (78%) than the HIV positives 4 (22%). The extreme of age groups and the early timing of deaths may be a result of lack of monitoring tests for second line drugs toxicities since most of these reagents are out of stock at the admitting hospital and peripheral decentralized sites. The programme should mobilize funds to ensure that all enrolled MDR-TB patients have access to these tests.
Trends of treatment Success rate of DR-TB enrolled for MDR-TB treatment: 2010 – 2014