OUTCOME OF COMMUNITY BASED THERAPY OF MULTI DRUG RESISTANT TUBERCULOSIS PATIENTS TREATED IN A TERTIARY CARE HOSPITAL OF KHYBER PAKHTUNKHWA

Abstract

OBJECTIVES: The objective of this study was to determine the treatment outcomeof MDR-TB patients in a tertiary care hospital that acts as provincial referencepoint for MDR TB in Khyber Pakhtunkhwa province of PakistanSETTING: All cases of MDR-TB registered at Lady Reading Hospital Peshawarfrom October 2008 to December 2011 prior to the implementation of a formalProgrammatic Management of Drug Resistant TB (PMDT) by National TB ControlProgramme (NTP).METHODOLOGY: It was a cross sectional study to find out the outcome ofMDR TB patients who received ambulatory community based treatment. Patientswere provided with free drugs only and no other social or travel supportwas available due to lack of resources. Smear microscopy was available free ofcost whereas sputum culture sensitivity was not. No tools for strict supervisionand ensuring compliance were available except for a volunteer treatment supporterand contact by mobile phones.RESULTS: 341 MDR-TB patients were registered during the period of the studyout of which 145 (42.8%) were male and 196 (56.2%) were females. 221(64.8%)patients were between 9 - 30 years, 113 (33.1%) were between 31-60 years and7 (2.1%) patients were above 61 years of age. The treatment outcome of theregistered patients was that 134 (39.3%) patients completed their treatment,80(23.5%) were cured, 70 (20.5%) died during the treatment, 50(14.7%) defaultedand 7(2.1%) were transferred out during the treatment.CONCLUSION: Community based outpatient treatment of multidrug-resistanttuberculosis can be an effective strategy. High default rate of 14.5 % suggeststhat MDR TB requires a strong system for treatment supervision. Compliancewith therapy can’t be sustained if the supervision mechanisms are weak.