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Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa
Background: Recent gains in TB control in South Africa are being reversed by drug-resistant tuberculosis (MDR-TB and XDR-TB), which has a high mortality, is a threat to health care workers, and is prohibitively costly to treat. MDR-TB has been supplanted by XDR-TB, resistance beyond XDR-TB, and prog...
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| Format: | Thesis |
| Language: | English |
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Department of Medicine
2017
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| _version_ | 1867614219387535360 |
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| access_status_str | Open Access |
| author | Pietersen, Gerbrecht Elizabeth |
| author2 | Dheda, Keertan |
| author_browse | Dheda, Keertan Pietersen, Gerbrecht Elizabeth |
| author_facet | Dheda, Keertan Pietersen, Gerbrecht Elizabeth |
| author_sort | Pietersen, Gerbrecht Elizabeth |
| collection | Thesis |
| description | Background: Recent gains in TB control in South Africa are being reversed by drug-resistant tuberculosis (MDR-TB and XDR-TB), which has a high mortality, is a threat to health care workers, and is prohibitively costly to treat. MDR-TB has been supplanted by XDR-TB, resistance beyond XDR-TB, and programmatically incurable TB. Short-term treatment-related outcomes of XDR-TB patients are known to be poor. However, there are no prospective data to inform longterm treatment-related outcomes, design of effective XDR-TB treatment regimens, and public health interventions required to interrupt transmission. In particular, the utility of certain costly drugs, e.g. capreomycin, for the treatment of XDR-TB remain unclear. There are also few data about how these characteristics differ in HIV-infected persons. Finally, little is known about the experiences of patients living with XDR-TB. This thesis aims to provide best practice evidence to promote drug-resistant TB control in high burden TB and HIV syndemic countries. Methods: We prospectively followed two cohorts of adult South African XDR-TB patients who received hospital and community treatment, which included a capreomycin and PAS-based regimen: (i) cohort A (n=107) from 3 provinces were diagnosed between August 2002 and February 2008 (retrospectively identified) and then prospectively followed up till August 2012; (ii) cohort B (n=273) from 2 provinces were prospectively identified between October 2008 and October 2012 and followed up till October 2014. Strain typing and drug susceptibility testing were performed and treatment-related outcomes were determined. In-depth interviews were conducted with therapeutically destitute patients from cohort B (n=12) and were home-discharged from hospital back to the community. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/24499 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:48:33.985Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2017 |
| publishDateRange | 2017 |
| publishDateSort | 2017 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/24499 Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa Pietersen, Gerbrecht Elizabeth Dheda, Keertan Medicine Epidemiology, Background: Recent gains in TB control in South Africa are being reversed by drug-resistant tuberculosis (MDR-TB and XDR-TB), which has a high mortality, is a threat to health care workers, and is prohibitively costly to treat. MDR-TB has been supplanted by XDR-TB, resistance beyond XDR-TB, and programmatically incurable TB. Short-term treatment-related outcomes of XDR-TB patients are known to be poor. However, there are no prospective data to inform longterm treatment-related outcomes, design of effective XDR-TB treatment regimens, and public health interventions required to interrupt transmission. In particular, the utility of certain costly drugs, e.g. capreomycin, for the treatment of XDR-TB remain unclear. There are also few data about how these characteristics differ in HIV-infected persons. Finally, little is known about the experiences of patients living with XDR-TB. This thesis aims to provide best practice evidence to promote drug-resistant TB control in high burden TB and HIV syndemic countries. Methods: We prospectively followed two cohorts of adult South African XDR-TB patients who received hospital and community treatment, which included a capreomycin and PAS-based regimen: (i) cohort A (n=107) from 3 provinces were diagnosed between August 2002 and February 2008 (retrospectively identified) and then prospectively followed up till August 2012; (ii) cohort B (n=273) from 2 provinces were prospectively identified between October 2008 and October 2012 and followed up till October 2014. Strain typing and drug susceptibility testing were performed and treatment-related outcomes were determined. In-depth interviews were conducted with therapeutically destitute patients from cohort B (n=12) and were home-discharged from hospital back to the community. 2017-06-06T09:43:25Z 2017-06-06T09:43:25Z 2017 Doctoral Thesis Doctoral PhD http://hdl.handle.net/11427/24499 eng application/pdf application/pdf Department of Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Medicine Epidemiology, Pietersen, Gerbrecht Elizabeth Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa |
| thesis_degree_str | Doctoral |
| title | Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa |
| title_full | Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa |
| title_fullStr | Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa |
| title_full_unstemmed | Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa |
| title_short | Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa |
| title_sort | molecular epidemiology susceptibility profiles outcomes and transmission dynamics in patients with extensively drug resistant tuberculosis xdr tb in two provinces of south africa |
| topic | Medicine Epidemiology, |
| url | http://hdl.handle.net/11427/24499 |
| work_keys_str_mv | AT pietersengerbrechtelizabeth molecularepidemiologysusceptibilityprofilesoutcomesandtransmissiondynamicsinpatientswithextensivelydrugresistanttuberculosisxdrtbintwoprovincesofsouthafrica |