Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
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{"title"=>"Effectiveness of the standard WHO recommended retreatment regimen (Category II) for tuberculosis in Kampala, Uganda: A prospective cohort study", "type"=>"journal", "authors"=>[{"first_name"=>"Edward C.", "last_name"=>"Jones-López", "scopus_author_id"=>"8986330000"}, {"first_name"=>"Irene", "last_name"=>"Ayakaka", "scopus_author_id"=>"25222321200"}, {"first_name"=>"Jonathan", "last_name"=>"Levin", "scopus_author_id"=>"7403284470"}, {"first_name"=>"Nancy", "last_name"=>"Reilly", "scopus_author_id"=>"14123807100"}, {"first_name"=>"Francis", "last_name"=>"Mumbowa", "scopus_author_id"=>"15842153000"}, {"first_name"=>"Scott", "last_name"=>"Dryden-Peterson", "scopus_author_id"=>"36116458100"}, {"first_name"=>"Grace", "last_name"=>"Nyakoojo", "scopus_author_id"=>"37073139200"}, {"first_name"=>"Kevin", "last_name"=>"Fennelly", "scopus_author_id"=>"8780726300"}, {"first_name"=>"Beth", "last_name"=>"Temple", "scopus_author_id"=>"36188890000"}, {"first_name"=>"Susan", "last_name"=>"Nakubulwa", "scopus_author_id"=>"25223527700"}, {"first_name"=>"Moses L.", "last_name"=>"Joloba", "scopus_author_id"=>"6603733958"}, {"first_name"=>"Alphonse", "last_name"=>"Okwera", "scopus_author_id"=>"7004821191"}, {"first_name"=>"Kathleen D.", "last_name"=>"Eisenach", "scopus_author_id"=>"7004925520"}, {"first_name"=>"Ruth", "last_name"=>"McNerney", "scopus_author_id"=>"7003915692"}, {"first_name"=>"Alison M.", "last_name"=>"Elliott", "scopus_author_id"=>"7201419696"}, {"first_name"=>"Jerrold J.", "last_name"=>"Ellner", "scopus_author_id"=>"7103270093"}, {"first_name"=>"Peter G.", "last_name"=>"Smith", "scopus_author_id"=>"55723620700"}, {"first_name"=>"Roy D.", "last_name"=>"Mugerwa", "scopus_author_id"=>"7004481149"}], "year"=>2011, "source"=>"PLoS Medicine", "identifiers"=>{"pmid"=>"21423586", "doi"=>"10.1371/journal.pmed.1000427", "sgr"=>"79953693008", "isbn"=>"1549-1277", "scopus"=>"2-s2.0-79953693008", "issn"=>"15491277", "pui"=>"361559650"}, "id"=>"2c183006-e105-374e-af04-b1c1899875e7", "abstract"=>"BACKGROUND: Each year, 10%-20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated.\\n\\nMETHODS AND FINDINGS: From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12-33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10-5.22), HIV infection (2.16; 1.01-4.61), age (aOR for 10-year increase 1.59; 1.13-2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04-1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p<0.0001). Multidrug-resistant TB at enrollment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0-53.4) and HIV-uninfected (14.7; 4.1-52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≥200; 3.0-18.8) and Karnofsky score <70 (2.1; 1.1-4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1-10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0-3.5).\\n\\nCONCLUSIONS: The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients.", "link"=>"http://www.mendeley.com/research/effectiveness-standard-recommended-retreatment-regimen-category-ii-tuberculosis-kampala-uganda-prosp", "reader_count"=>97, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>7, "Librarian"=>1, "Student > Doctoral Student"=>7, "Researcher"=>20, "Student > Ph. D. Student"=>10, "Student > Postgraduate"=>7, "Student > Master"=>25, "Other"=>5, "Student > Bachelor"=>7, "Lecturer > Senior Lecturer"=>4, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>7, "Librarian"=>1, "Student > Doctoral Student"=>7, "Researcher"=>20, "Student > Ph. D. Student"=>10, "Student > Postgraduate"=>7, "Student > Master"=>25, "Other"=>5, "Student > Bachelor"=>7, "Lecturer > Senior Lecturer"=>4, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>7, "Agricultural and Biological Sciences"=>9, "Business, Management and Accounting"=>2, "Computer Science"=>1, "Engineering"=>1, "Environmental Science"=>2, "Nursing and Health Professions"=>8, "Biochemistry, Genetics and Molecular Biology"=>4, "Materials Science"=>1, "Mathematics"=>1, "Medicine and Dentistry"=>50, "Social Sciences"=>9, "Immunology and Microbiology"=>2}, "reader_count_by_subdiscipline"=>{"Materials Science"=>{"Materials Science"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>50}, "Social Sciences"=>{"Social Sciences"=>9}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>7}, "Environmental Science"=>{"Environmental Science"=>2}, "Engineering"=>{"Engineering"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>9}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>8}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>4}}, "reader_count_by_country"=>{"United States"=>4, "Japan"=>1, "Brazil"=>1, "United Kingdom"=>1, "Malaysia"=>1, "Switzerland"=>1}, "group_count"=>6}

Scopus | Further Information

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  • {"files"=>["https://ndownloader.figshare.com/files/395806", "https://ndownloader.figshare.com/files/395847"], "description"=>"<div><h3>Background</h3><p>Each year, 10%–20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated.</p><h3>Methods and Findings</h3><p>From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12–33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10–5.22), HIV infection (2.16; 1.01–4.61), age (aOR for 10-year increase 1.59; 1.13–2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04–1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (<em>p</em><0.0001). Multidrug-resistant TB at enrolment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0–53.4) and HIV-uninfected (14.7; 4.1–52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≥200; 3.0–18.8) and Karnofsky score <70 (2.1; 1.1–4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1–10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0–3.5).</p><h3>Conclusions</h3><p>The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients.</p><h3></h3><p><em>Please see later in the article for the Editors' Summary</em></p></div>", "links"=>[], "tags"=>["recommended", "retreatment", "regimen", "tuberculosis", "prospective", "cohort"], "article_id"=>138176, "categories"=>["Medicine", "Cancer"], "users"=>["Edward C. Jones-López", "Irene Ayakaka", "Jonathan Levin", "Nancy Reilly", "Francis Mumbowa", "Scott Dryden-Peterson", "Grace Nyakoojo", "Kevin Fennelly", "Beth Temple", "Susan Nakubulwa", "Moses L. Joloba", "Alphonse Okwera", "Kathleen D. Eisenach", "Ruth McNerney", "Alison M. Elliott", "Jerrold J. Ellner", "Peter G. Smith", "Roy D. Mugerwa"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000427.s001", "https://dx.doi.org/10.1371/journal.pmed.1000427.s002"], "stats"=>{"downloads"=>2, "page_views"=>19, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Effectiveness_of_the_Standard_WHO_Recommended_Retreatment_Regimen_Category_II_for_Tuberculosis_in_Kampala_Uganda_A_Prospective_Cohort_Study/138176", "title"=>"Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2011-03-15 02:16:16"}
  • {"files"=>["https://ndownloader.figshare.com/files/791142"], "description"=>"a<p>Unless specified.</p>b<p><i>p</i>-Values based on a chi-squared test for categorical variables and a <i>t</i>-test for continuous variables.</p>c<p>One HIV-infected participant did not have CD4 result.</p><p>AFB, acid-fast bacilli; CD4, CD4+ T lymphocytes; H, isoniazid; R, rifampicin; n/a, not available; SD, standard deviation.</p>", "links"=>[], "tags"=>["characteristics", "288", "hospitalized", "retreatment", "tb", "patients", "hiv"], "article_id"=>461485, "categories"=>["Medicine", "Virology"], "users"=>["Edward C. Jones-López", "Irene Ayakaka", "Jonathan Levin", "Nancy Reilly", "Francis Mumbowa", "Scott Dryden-Peterson", "Grace Nyakoojo", "Kevin Fennelly", "Beth Temple", "Susan Nakubulwa", "Moses L. Joloba", "Alphonse Okwera", "Kathleen D. Eisenach", "Ruth McNerney", "Alison M. Elliott", "Jerrold J. Ellner", "Peter G. Smith", "Roy D. Mugerwa"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000427.t001", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_characteristics_of_288_hospitalized_retreatment_TB_patients_in_Kampala_Uganda_according_to_HIV_infection_status_/461485", "title"=>"Baseline characteristics of 288 hospitalized retreatment TB patients in Kampala, Uganda, according to HIV infection status.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-03-15 00:24:45"}
  • {"files"=>["https://ndownloader.figshare.com/files/791079"], "description"=>"a<p>For HIV-uninfected participants, the potential risk factors considered were resistance status, adherence to TB treatment, duration of TB symptoms, reason for being retreated, and BACTEC days to positivity at baseline, with age and sex as potential confounders.</p>b<p>For HIV-infected participants, the potential risk factors and confounders considered were as for HIV-uninfected with in addition a composite factor measuring baseline CD4 count and ART status; this factor has five levels namely “CD4≥200,” “CD4 50–199+no ART,” “CD4 50–199+ART,” “CD4<50+no ART,” and “CD4<50+ART.”</p>c<p>Category includes participants who were fully adherent with treatment and those that missed a few doses.</p><p>CI, confidence interval; H, isoniazid; n/a, not available; R, rifampicin.</p>", "links"=>[], "tags"=>["fitting", "cox", "proportional", "hazards", "regression", "models", "hiv"], "article_id"=>461397, "categories"=>["Medicine", "Virology"], "users"=>["Edward C. Jones-López", "Irene Ayakaka", "Jonathan Levin", "Nancy Reilly", "Francis Mumbowa", "Scott Dryden-Peterson", "Grace Nyakoojo", "Kevin Fennelly", "Beth Temple", "Susan Nakubulwa", "Moses L. Joloba", "Alphonse Okwera", "Kathleen D. Eisenach", "Ruth McNerney", "Alison M. Elliott", "Jerrold J. Ellner", "Peter G. Smith", "Roy D. Mugerwa"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000427.t003", "stats"=>{"downloads"=>3, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mortality_results_of_fitting_Cox_proportional_hazards_regression_models_by_HIV_status_/461397", "title"=>"Mortality: results of fitting Cox proportional hazards regression models by HIV status.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-03-15 00:23:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/790919"], "description"=>"<p>Kaplan-Meier curves by HIV status.</p>", "links"=>[], "tags"=>["curves", "hiv"], "article_id"=>461276, "categories"=>["Medicine", "Virology"], "users"=>["Edward C. Jones-López", "Irene Ayakaka", "Jonathan Levin", "Nancy Reilly", "Francis Mumbowa", "Scott Dryden-Peterson", "Grace Nyakoojo", "Kevin Fennelly", "Beth Temple", "Susan Nakubulwa", "Moses L. Joloba", "Alphonse Okwera", "Kathleen D. Eisenach", "Ruth McNerney", "Alison M. Elliott", "Jerrold J. Ellner", "Peter G. Smith", "Roy D. Mugerwa"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000427.g002", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Kaplan_Meier_curves_by_HIV_status_/461276", "title"=>"Kaplan-Meier curves by HIV status.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-03-15 00:21:16"}
  • {"files"=>["https://ndownloader.figshare.com/files/791020"], "description"=>"a<p>Odds ratios adjusted for other terms in the model including HIV status, drug resistance status, duration of TB symptoms, age, sex, adherence, and duration since last TB episode.</p>b<p>All patients with MDR had an unsuccessful outcome so the odds ratio cannot be estimated; 18 observations were thus omitted from the model.</p>c<p>Category includes participants that were fully adherent with treatment and those that missed a few doses.</p><p>H, isoniazid; R, rifampicin.</p>", "links"=>[], "tags"=>["fitting", "logistic", "regression", "models", "factors", "unsuccessful"], "article_id"=>461369, "categories"=>["Medicine", "Virology"], "users"=>["Edward C. Jones-López", "Irene Ayakaka", "Jonathan Levin", "Nancy Reilly", "Francis Mumbowa", "Scott Dryden-Peterson", "Grace Nyakoojo", "Kevin Fennelly", "Beth Temple", "Susan Nakubulwa", "Moses L. Joloba", "Alphonse Okwera", "Kathleen D. Eisenach", "Ruth McNerney", "Alison M. Elliott", "Jerrold J. Ellner", "Peter G. Smith", "Roy D. Mugerwa"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000427.t002", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Results_of_fitting_multiple_logistic_regression_models_for_factors_associated_with_unsuccessful_treatment_outcome_n_288_/461369", "title"=>"Results of fitting multiple logistic regression models for factors associated with unsuccessful treatment outcome (<i>n</i> = 288).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-03-15 00:22:49"}
  • {"files"=>["https://ndownloader.figshare.com/files/790838"], "description"=>"<p>Study profile during the 8-mo TB retreatment period.</p>", "links"=>[], "tags"=>["8-mo", "tb", "retreatment"], "article_id"=>461185, "categories"=>["Medicine", "Virology"], "users"=>["Edward C. Jones-López", "Irene Ayakaka", "Jonathan Levin", "Nancy Reilly", "Francis Mumbowa", "Scott Dryden-Peterson", "Grace Nyakoojo", "Kevin Fennelly", "Beth Temple", "Susan Nakubulwa", "Moses L. Joloba", "Alphonse Okwera", "Kathleen D. Eisenach", "Ruth McNerney", "Alison M. Elliott", "Jerrold J. Ellner", "Peter G. Smith", "Roy D. Mugerwa"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000427.g001", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_profile_during_the_8_mo_TB_retreatment_period_/461185", "title"=>"Study profile during the 8-mo TB retreatment period.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-03-15 00:19:45"}

PMC Usage Stats | Further Information

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Relative Metric

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