Treatment for RR/MDR tuberculosis: a comparative analysis of programmatic outcome indicators between Buenaventura and other municipalities of Valle del Cauca-Colombia

Abstract

Introduction. Proper management of multi-resistant tuberculosis is a prioritized strategy for the tuberculosis control worldwide.
Objective. To evaluate differences with respect to demographic, clinical characteristics and programmatic indicators of the cohort of patients with confirmed diagnosis of RR/MDR TB from Buenaventura, compared to a cohort of the other municipalities from the state of Valle del Cauca – Colombia, 2013-2016.
Materials and methods. Analytical cohort study that compared records of >15 years of age with RR/MDR TB from Buenaventura tuberculosis program (uses para-aminosalicylic acid -PAS) versus the other municipalities of Valle del Cauca (do not uses PAS).
Results. 99 cases were recorded, the median age was 40 years (IQR 26-53); in Buenaventura 56% were women, in the other municipalities men predominated 67%; 95% had health insurance. The most common comorbidity was diabetes (14%). Adverse Reactions to Antituberculosis Medications (AFR) in Buenaventura were 1.3 times higher than in the other municipalities (OR 2.3 95% CI 0.9933-5.568; p=0.04). In Buenaventura, 5% of the cases died compared to the 15% reported in the other municipalities. There were no treatment failures in Buenaventura, but 35% loss to follow-up was reported. Treatment success was higher in Buenaventura, with 56%.
Conclusion. A strengthened program in Buenaventura presented better programmatic results than the other municipalities of Valle del Cauca. Access to molecular tests, the availability of shortened treatments and continuous monitoring to identify RAFAS is a path forward for all other control programs.