RESUMEN
SETTING: Undernourishment is prevalent among tuberculosis (TB) patients. Nutritional support is given to TB patients to prevent and treat undernourishment; it is also used to improve treatment outcomes and as an incentive to keep patients on treatment. OBJECTIVE: To determine whether nutritional support is associated with a reduction in the risk of loss to follow-up (LTFU) among TB patients in Kenya. DESIGN: This was a retrospective cohort study using national programmatic data. Records of 362 685 drug-susceptible TB patients from 2012 to 2015 were obtained from Treatment Information from Basic Unit (TIBU), a national case-based electronic data recording system. Patients who were LTFU were compared with those who completed treatment. RESULTS: Nutrition counselling was associated with an 8% reduction in the risk of LTFU (RR 0.92, 95%CI 0.89-0.95), vitamins were associated with a 7% reduction (adjusted RR [aRR] 0.93, 95%CI 0.90-0.96) and food support was associated with a 10% reduction (aRR 0.90, 95%CI 0.87-0.94). Among patients who received food support, the addition of nutrition counselling was associated with a 23% reduction in the risk of LTFU (aRR 0.77, 95%CI 0.67-0.88). CONCLUSION: Nutritional support was associated with a reduction in the risk of LTFU. Providing nutrition counselling is important for patients receiving food support.
Asunto(s)
Antituberculosos/uso terapéutico , Desnutrición/terapia , Apoyo Nutricional/métodos , Tuberculosis/terapia , Adolescente , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Kenia , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Tuberculosis/complicaciones , Tuberculosis/diagnóstico , Adulto JovenRESUMEN
SETTING: Three human immunodeficiency virus (HIV) care clinics in Eastern Province, Kenya. OBJECTIVES: To establish rates of treatment completion, loss to follow-up, adverse drug reactions, tuberculosis (TB) disease and mortality among 606 HIV-infected children during 6 months of isoniazid preventive therapy (IPT). DESIGN: Retrospective record review. RESULTS: Of 606 HIV-infected children started on IPT, 556 (91.7%) successfully completed treatment, while 20 (3.3%) completed with interruptions. Cumulatively, 30 children (4.9%) did not complete IPT: 4 (0.7%) were lost to follow-up, 4 (0.7%) discontinued because of treatment interruptions, 2 (0.3%) developed adverse drug reactions, 1 developed a chronic cough, 1 was transferred to a non-IPT facility and 18 (3%) developed TB, including 2 who eventually died. TB disease was diagnosed in a median of 3 weeks (interquartile range [IQR] 2-16) post-IPT initiation. The median CD4 cell count for those aged 1-4 years who developed TB disease was 1023 cells/mm(3) (IQR 375-1432), while for those aged 5-14 years it was 149 cells/mm(3) (IQR 16-332). Isoniazid resistance was not detected in the four culture-confirmed TB cases. CONCLUSION: The high treatment completion, low loss to follow-up rate and few adverse drug reactions affirm the feasibility of IPT provision to children in HIV care clinics.