Retrospective record review of pregnant women treated for rifampicin-resistant tuberculosis in South Africa.

BACKGROUND: Tuberculosis (TB) is amongst the top five causes of death in women of childbearing age (15-≤44 years). Little is known about treatment of pregnant women with drug-resistant TB (DR-TB). Treatment for pregnant women remains challenging and more complex in DR-TB/HIV co-infection, where an evidence-based guide to clinical practice is limited. The study reviewed treatment and pregnancy outcomes and birth outcomes of their new-born in a cohort of pregnant women with DR-TB from three MDR-TB hospitals during 2010 and 2018. DESIGN/METHODS: Data were extracted from: TB register and patient clinic notes using a standardized case record form. Information on DR-TB treatment, pregnancy and Adverse Drug Events (ADEs) of twenty-six pregnant women treated with individualized second-line TB medications were captured. The frequency of favourable and adverse outcomes regarding disease and pregnancy were evaluated. RESULTS: The mean age was 29 years (SD ±5.1), with the minimum and maximum age of 21 and 40 years, respectively. Eleven (42.3%) were previously treated with first-line TB drugs, 11 (42.3%) never treated before and 4 (15.4%) were previously treated for DR-TB. Of the 26 women, 15 (57.7%) had at least one ADE, but most had more than one ADE. Seventeen women were successfully treated, and 22 live births recorded. Live birth outcome was significantly associated with trimester of initiation of DR-TB treatment (p = 0.036). The proportion of live births for the pregnancy trimester when DR-TB treatment was initiated, were 60.0%, 90.9% and 100.0%, for first, second and third trimester, respectively. CONCLUSION: DR-TB treatment should be delayed until after the first trimester. Routine pharmacovigilance surveillance integrated antenatal and delivery services with an integrated record of DR-TB treatment during pregnancy is recommended. Prospective studies using standardised case record forms for DR-TB treatment for pregnant women could provide more insight on the effect of DR-TB treatment on the birth outcome.

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province.

BACKGROUND: Since 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa. This research investigated the influence of routinely captured demographic and clinical or programme variables on death in TB patients in the Free State Province. METHODS: A retrospective review of case information captured in the Electronic TB register (ETR.net) over the years 2003 to 2012 was conducted. Extracted data were subjected to descriptive and logistic regression analyses. The outcome variable was defined as all registered TB cases with 'died' as the recorded outcome. The variables associated with increased or decreased odds of dying in TB patients were established. The univariate and adjusted odds ratios (OR and AOR) together with their corresponding 95% confidence intervals (CI) were estimated, taking the clustering effect of the districts into account. RESULTS: Of the 190,472 TB cases included in the analysis, 30,991 (16.3%) had 'died' as the recorded treatment outcome. The proportion of TB patients that died increased from 15.1% in 2003 to 17.8% in 2009, before declining to 15.4% in 2012. The odds of dying was incrementally higher in the older age groups: 8-17 years (AOR: 2.0; CI: 1.5-2.7), 18-49 years (AOR: 5.8; CI: 4.0-8.4), 50-64 years (AOR: 7.7; CI: 4.6-12.7), and ≥65 years (AOR: 14.4; CI: 10.3-20.2). Other factors associated with increased odds of mortality included: HIV co-infection (males - AOR: 2.4; CI: 2.1-2.8; females - AOR: 1.9; CI: 1.7-2.1) or unknown HIV status (males - AOR: 2.8; CI: 2.5-3.1; females - AOR: 2.4; CI: 2.2-2.6), having a negative (AOR: 1.4; CI: 1.3-1.6) or a missing (AOR: 2.1; CI: 1.4-3.2) pre-treatment sputum smear result, and being a retreatment case (AOR: 1.3; CI: 1.2-1.4). CONCLUSIONS: Although mortality in TB patients in the Free State has been falling since 2009, it remained high at more than 15% in 2012. Appropriately targeted treatment and care for the identified high-risk groups could be considered.