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Characteristics and Outcomes of a Population of Tuberculosis Inpatients in Lilongwe, Malawi

Characteristics and Outcomes of a Population of Tuberculosis Inpatients in Lilongwe, Malawi. Mina Hosseinipour , MD, MPH Clinical Director UNC Project Lilongwe, Malawi. Background and Methods. No TB drug resistance data using Molecular Drug Susceptibility Testing exists in Malawi.

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Characteristics and Outcomes of a Population of Tuberculosis Inpatients in Lilongwe, Malawi

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  1. Characteristics and Outcomes of a Population of Tuberculosis Inpatients in Lilongwe, Malawi Mina Hosseinipour, MD, MPH Clinical Director UNC Project Lilongwe, Malawi

  2. Background and Methods • No TB drug resistance data using Molecular Drug Susceptibility Testing exists in Malawi. • WHO estimates for Malawi suggest MDR prevalence of 7.7% (0-18.1) among retreatment patients. • Study design: Prospective, observational cohort study of adult, primarily retreatment cases, Tuberculosis inpatients at the Bwaila TB ward in Lilongwe Malawi. • Follow-up of 2 months for retreatment patients • Follow-up of 2 weeks for first treatment • Procedures • Demographic and clinical questionnaires • Chest X-ray • HIV status, CD4 and HIVRNA (if HIV infected) • TB laboratory (Baseline) • Auramine-O smear fluorescent microscopy, • Culture: LJ (standard of care) and MGIT culture • Drug sensitivity assays (Genotype® MTBDR and direct susceptibility testing)

  3. Enrollment and Drug ResistanceProfiles • 88 TB inpatients enrolled: • 88% re-treatment, • 42% smear positive • 93% pulmonary TB • 74% HIV co-infected • 38/88 (43%) MGIT and 28 (32%) LJ cultures were positive at baseline with a mean time to positivity of 12.1 (Range 1-42) and 21.5 (Range 7-58) days, respectively. • Estimated MDR prevalence: 4% • 3 MDRTB identified /77 retreatment cases • Only 1/3 (33%) MDRTB patients was identified with LJ at baseline. • No XDR-TB was detected with Hain Genotype® MTBDRsl. All MDR cases started second line TB therapy in mean of 7 days.

  4. Vital Outcomes and Conclusions • Vital Outcomes: • Five patients (6%) died through 8 weeks of follow-up • 3/77 (4%) retreatment • 2/11 (18%) first treatment • Lower mean hemoglobin at admission was associated with mortality: 10.5 vs. 7.5; p<0.01; CI 9.8-11.0 • No association by MDR status, smear status, HIV status • Conclusions • The MDRTB burden among retreatment patients approximates WHO estimates. • MDRTB patients are not routinely identified with sputum smear or LJ. • More efficient TB culture and drug susceptibility profiling technology should be adopted.

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