Outcomes in Adolescents Undergoing Treatment for Drug-Resistant Tuberculosis in Cape Town, South Africa, 2008-2013

Background: There is limited data on outcomes of adolescents with drug-resistant tuberculosis (DR-TB).

Objectives: To describe patient outcomes and factors associated with outcomes of adolescents diagnosed with DR-TB in Khayelitsha, South Africa.

Patients and Methods: A retrospective analysis of data for adolescents aged 10-19 years who were diagnosed with DR-TB between January 2008 and August 2013 was conducted. The proportions of adolescents with treatment success (cure and treatment completion), failure of treatment, those lost from treatment, and those who died were calculated and compared by HIV status. Proportions and odd ratios are presented.

Results: Seventy-one adolescents were diagnosed with DR-TB. Six (8%) were lost to care before treatment could be initiated. The median age of those started on treatment was 18 years (IQR 15.8-18.9). Eighteen (27.7%) were HIV infected. Of the 44 adolescents with final treatment outcomes, 36.4% (n = 16) were successfully treated, 9.1% (n = 4) died, 11.4% (n = 9) failed treatment and 43.2% (n = 19) were lost from treatment (treatment interrupted for ≥ 2 consecutive months). Three of the four patients who died, died within two months of starting therapy. Loss from treatment, and treatment success (cure or treatment completion) did not differ between HIV infected and un-infected adolescents, OR: 2.0, (95% CI 0.56-7.50), P = 0.27; and OR: 1.2 (95% CI 0.37-4.43), P = 0.71, respectively. All five patients who failed treatment and one of those lost from treatment subsequently died. Overall mortality was 12.1/100 person years.

Conclusions: HIV infected and uninfected adolescents with DR-TB experienced poor outcomes with high proportions of mortality, treatment failure and loss from treatment. Mortality occurred early in the treatment period suggesting delayed presentation and/or diagnosis. Innovative and targeted strategies are needed to encourage early presentation and improve adherence to treatment among adolescents.

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Keywords: Extensively Drug-Resistant Tuberculosis; Adolescent; Patient Outcome Assessment

Authors: Sizulu Moyo, Jennifer Joan Furin, Jennifer Hughes, Johnny Daniels, Leigh Snyman, Odelia Muller, Vivian Cox, Amir Shroufi and Helen Cox