Efficacy of an unsupervised ambulatory treatment regimen for smear-negative pulmonary tuberculosis and tuberculous pleural effusion in Malawi

A. D. Harries*, D. S. Nyangulu, H. Banda, C. Kang'ombe, L. Van Der Paal, J. R. Glynn, V. R. Subramanyam, J. J. Wirima, F. M. Salaniponi, D. Maher, P. Nunn

*Corresponding author for this work

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Abstract

Setting: Queen Elizabeth Central Hospital, Blantyre, and Zomba Central Hospital, Zomba, Malawi. Objective: To evaluate treatment outcome of unsupervised ambulatory treatment (2R3H3Z3/2TH[EH]/4H) in Blantyre and 'standard' treatment (1STH [SEH]/11TH[EH]) in Zomba in human immunodeficiency virus (HIV) seropositive and seronegative patients with smear-negative pulmonary tuberculosis (PTB) and pleural TB. Design: All patients with smear-negative and pleural TB registered between 1 April and 31 December 1995 were assessed for enrolment in the study. Study patients were followed up and 12-month treatment outcomes were recorded. Results: A total of 434 patients, 296 with smear-negative PTB and 138 with pleural TB, were enrolled: 366 (84%) of patients were HIV-positive; 220 (51%) completed treatment, and 144 (33%) died by 12 months. In patients from Blantyre and Zomba, baseline characteristics were similar, apart from older age in those from Zomba, and the proportion of patients who completed treatment and died were similar. In both sites, significantly higher case fatality rates were found in older patients, HIV-positive patients and patients with pulmonary parenchymal lung disease. Conclusion: Unsupervised ambulatory treatment evaluated in this study had an efficacy similar to that of 'standard' treatment. For operational reasons, however, it will not be recommended for widespread use in Malawi's National Tuberculosis Control Programme.

Original languageEnglish
Pages (from-to)402-408
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume3
Issue number5
Publication statusPublished - May 1999
Externally publishedYes

Keywords

  • Ambulatory treatment
  • HIV
  • Pleural tuberculosis
  • Smear-negative tuberculosis

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    Harries, A. D., Nyangulu, D. S., Banda, H., Kang'ombe, C., Van Der Paal, L., Glynn, J. R., ... Nunn, P. (1999). Efficacy of an unsupervised ambulatory treatment regimen for smear-negative pulmonary tuberculosis and tuberculous pleural effusion in Malawi. International Journal of Tuberculosis and Lung Disease, 3(5), 402-408.