Volume 93, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



In tuberculosis (TB)–prevalent settings, patients admitted for retreatment of TB may account for a high burden of poor treatment outcome. We performed a retrospective cohort study to characterize retreatment patients and outcomes at a TB referral hospital in northern Tanzania. From 2009 to 2013, 185 patients began a retreatment regimen, the majority for relapse after prior treatment completion. Men accounted for an unexpected majority (88%), 36 (20%) were human immunodeficiency virus (HIV) infected and for 45 (24%) mining was their primary occupation. A poor outcome (death, default, or persistent smear positivity after 7 months of treatment) was found in 37 (23%). HIV infection was the only significant predictor of poor outcome (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI] = 1.07–5.83, = 0.034). Interventions to minimize need for retreatment or improve retreatment success may be regionally specific. In our setting, community-based diagnosis and management among at-risk subpopulations such as miners and those HIV infected appear of highest yield.


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  1. World Health Organization, 2015. World Health Organization Country Fact Sheet, Tuberculosis, Tanzania, 2015. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/tb/country/data/profiles/en/. Accessed March 31, 2015. [Google Scholar]
  2. Peloquin CA, Berning SE, Nitta AT, Simone PM, Goble M, Huitt GA, Iseman MD, Cook JL, Curran-Everett D, , 2004. Aminoglycoside toxicity: daily versus thrice-weekly dosing for treatment of mycobacterial diseases. Clin Infect Dis 38: 15381544.[Crossref] [Google Scholar]
  3. Bratviet M, Moen BE, Mashalla YJS, Maalim H, , 2003. Dust exposure during small-scale mining in Tanzania: a pilot study. Ann Occup Hyg 47: 235240. [Google Scholar]
  4. Rees D, Murrary J, , 2007. Silica, silicosis and tuberculosis. Int J Tuberc Lung Dis 11: 474484. [Google Scholar]
  5. United Republic of Tanzania: Ministry of Health and Social Welfare (MoH and SW), 2006. National TB and Leprosy Program, Clinical Guideline for TB Management. Dar es Salaam, United Republic of Tanzania: MoH and SW. [Google Scholar]
  6. Mpagama S, Heysell SK, Ndusilo ND, Kumburu HH, Lekule IA, Kisonga RM, Gratz J, Boeree MJ, Houpt ER, Kibiki GS, , 2013. Diagnosis and interim treatment outcomes from the first cohort of multidrug-resistant tuberculosis patients in Tanzania. PLoS One 8: e62034.[Crossref] [Google Scholar]
  7. Burton NT, Forson A, Lurie MN, Kudzawa S, Kwarteng E, Kwara A, , 2011. Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana. Trans R Soc Trop Med Hyg 105: 675682.[Crossref] [Google Scholar]
  8. Heysell SK, Mtabho C, Mpagama S, Mwaigwisya S, Ndusilo N, Pholwat S, Gratz J, Aarnouste R, Kibiki GS, Houpt ER, , 2011. A plasma drug activity assay for treatment optimization in tuberculosis patients. Antimicrob Agents Chemother 55: 58195825.[Crossref] [Google Scholar]
  9. Tostmann A, Mtabho CM, Semvua HH, van den Boogaard J, Kibiki GS, Boeree MJ, Aarnoutse RE, , 2013. Pharmacokinetics of first-line tuberculosis drugs in Tanzanian patients. Antimicrob Agents Chemother 57: 32083213.[Crossref] [Google Scholar]
  10. Hoa NB, Lauritsen JM, Rieder HL, , 2013. Changes in body weight and tuberculosis treatment outcome in Viet Nam. Int J Tuberc Lung Dis 17: 6166.[Crossref] [Google Scholar]
  11. Barroso EC, Pinheiro VGF, Facanha MC, Carvalho MRD, Moura ME, Campelo CL, Peloquin CA, Guerrant RL, Lima AAM, , 2009. Serum concentrations of rifampin, isoniazid and intestinal absorption, permeability in patients with multidrug resistant tuberculosis. Am J Trop Med Hyg 81: 322329. [Google Scholar]
  12. van Ingen J, Aarnoutse RE, Donald PR, Diacon AH, Dawson R, van Balen GP, Gillespie SH, Boeree MJ, , 2011. Why do we use 600 mg of rifampicin in tuberculosis treatment? Clin Infect Dis 52: e194e199.[Crossref] [Google Scholar]
  13. Reynolds J, Heysell SK, , 2014. Understanding pharmacokinetics to improve tuberculosis treatment outcome. Expert Opin Drug Metab Toxicol 10: 813823.[Crossref] [Google Scholar]
  14. Jacob ST, Banura P, Baeten JM, Moore CC, Meya D, Nakiyingi L, Burke R, Horton CL, Iga B, Wald A, Reynolds SJ, Mayanja-Kizza H, Scheld WM, , 2012. The impact of early monitored management on survival in hospitalized adult Ugandan patients with severe sepsis: a prospective intervention study. Crit Care Med 40: 20502058.[Crossref] [Google Scholar]
  15. Heysell SK, Thomas TA, Moll AP, Gandhi NR, Eksteen FJ, Babaria P, Roux L, Coovadia Y, Lallo U, Friedland G, Shah NS, , 2010. Blood cultures for the diagnosis of multidrug-resistant and extensively drug-resistant tuberculosis among HIV-infected patients from rural South Africa. BMC Infect Dis 10: 344.[Crossref] [Google Scholar]
  16. TB CARE I, 2014. International Standards for Tuberculosis Care, 3rd edition. The Hague, The Netherlands: TB CARE I. [Google Scholar]
  17. Srivastava S, Pasipanodya JG, Meek C, Leff R, Gumbo T, , 2011. Multidrug-resistant tuberculosis not due to noncompliance but to between-patient pharmacokinetic variability. J Infect Dis 204: 19511959.[Crossref] [Google Scholar]
  18. Stuckler D, Basu S, McKee M, Lurie M, , 2011. Mining and risk of tuberculosis in sub-Saharan Africa. Am J Public Health 101: 524530.[Crossref] [Google Scholar]
  19. Hnizdo E, Murray J, , 1998. Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners. Occup Environ Med 55: 496502.[Crossref] [Google Scholar]
  20. Churchyard G, Kleinschmidt I, Corbett EL, Murray J, Smit J, De Cock KM, , 2000. Factors associated with an increased case-fatality rate in HIV-infected and non-infected South African gold miners with pulmonary tuberculosis. Int J Tuberc Lung Dis 4: 705712. [Google Scholar]
  21. Basu S, Stuckler D, McKee M, , 2011. Addressing institutional amplifiers in the dynamics and control of tuberculosis epidemics. Am J Trop Med Hyg 84: 3037.[Crossref] [Google Scholar]

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  • Received : 10 Mar 2015
  • Accepted : 03 Apr 2015
  • Published online : 05 Aug 2015

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