mdr-tb in plhiv: impact and response commentaries
TRANSCRIPT
MDR-TB IN PLHIV: IMPACT AND RESPONSE
COMMENTARIES
Dr. Norbert Ndjeka MD, DHSM (Wits), MMed (Fam Med) (MED), Dip HIV Man (SA)
Director Drug-Resistant TB, TB and HIV National Department of Health
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HEALTH SERVICES IN SOUTH AFRICA
• Population: 50, 586 757
• Provinces – 9
• Districts - 53
• Sub districts - 253
• Health facilities – 4790
• MDR-TB beds: 2,500
• DR-TB treatment sites: 298
NC 2.2%
WC 10.5%
EC 13.5%
KZN 21.4% FS 5.5%
NW 6.4%
LP 11%
MP 7.2%
GP 22.4%
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GXP sites Culture / LPA sites NTBRL
TB Burden in RSA
TB patients initiated on treatment decreasing: 406,082 to 332,170 (2009 and 2013)
Treatment success rate: 80,9 % for 2012 cohort
MDR-TB numbers initiated on treatment doubled between 2010 and 2013 (5,313 to 10,719)
MDR-TB treatment success rate of 45 % (2011 cohort > 6,000)
XDR-TB treatment success rate varies between 15 and 20 %
TB/MDR-TB HIV Co-infection 60 to 80 %
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EC FS GP KZN LP MP NC NW WC Total
Success 29.3 46.3 44.7 58.9 50.4 41.5 32.8 48.6 35.5 44.8
Failed 10.3 3.9 1.6 2.9 7.9 3.1 10 2 4.6 4.9
0
10
20
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40
50
60
70Su
cce
ss &
Fai
lure
rat
e (%
)
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EC FS GP KZN LP MP NC NW WC Total
Died 32.4 20.1 17.7 10.2 14.2 24 21 26.1 13.7 17.7
Defaulted 23.8 21.4 17.9 10.2 26.8 18.9 27.7 9.5 34 19.8
0
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10
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35
40D
ied
an
d d
efau
lted
(%
)
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MDR-TB vs Pre-XDR-TB success rate, 2010-2011
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0
5
10
15
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45
50
2010 2011
Succ
ess
rate
(%
)
DR-TB type /year
MDR-TB + Amikacin/Kana
MDR-TB + Fluoroquinolone
MDR-TB
XDR-TB Treatment outcome (24 months) 2007-2010
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0
10
20
30
40
50
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Treatment Success Rate Defaulter Rate Mortality Rate Treatment failure rate
Pe
rce
nt
(%)
Indicator
2007
2008
2009
2010
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Treatment outcomes for MDR-TB in South Africa (2012 cohort)
Treatment success HIV +: 47% (95% CI 46-48) Treatment success HIV -: 48% (95% CI 46-50)
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Treatment Outcome All Cases HIV Positive On ART
Cured 2799 1844 1710
Treatment completed 1050 697 628
Failed 311 190 182
Defaulted 1906 1202 1025
Died 1546 1182 1033
Transferred out 169 104 87
Not evaluated 217 121 97
Still on treatment 216 144 133
Total 8214 5484 4895
Treatment Success Rate (%)
47% 46% 48%
HIV+ on ART = 89%
Remarks
HIV is a risk factor for MDR-TB ART roll out is important Availability of laboratory (DST) is critical MDR-TB/HIV care integration is very useful Ability to prove nosocomial infection is a
challenge in our setting because of the endemic nature of TB
MDR-TB among health care workers is another area of concern (HIV has not been linked to MDR-TB n the study in KZN by Dheda K although diabetes was associated with MDR-TB among HCWs in Western Cape)
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Priorities for TB Programme (Murphy RA)
Scale up of SLD treatment capacity
Invest in clinical laboratory
Patient support during treatment
Enhance infection control procedures
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Thank you
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