P65 Treating tuberculosis in rural South Africa

Abstract

Methods: All the patients admitted to the male and female Tuberculosis wards at a rural hospital in KwaZulu-Natal, South Africa, during a 1-month period were entered into a database. Basic demographic data were collected as well as information about HIV status, medications, complications and 1-month mortality. The area's tuberculosis (TB) incidence is 1046 per 100 000 and there is an HIV infection rate of 29%. Results: 70 patients were admitted during the time allocated. 89% were HIV positive. The mean CD4 count of the HIV positive patients was 114, however only 45% of patients were on ARVs at time of admission. 21% of patients had extrapulmonary TB. Only 17% were AFB positive, a further 9% had culture results back, two patients cultured proven multidrug resistant TB. Two patients had a history of completed XDR TB treatment. 10% patients developed drug induced hepatitis, 3% had pneumothoraces, 10% had coexistant renal impairment, 11% had neurological complications. There was a 23% 1-month mortality. No patients who were HIV negative died. 27% died of respiratory failure, 12% had hepatic failure, likely secondary to antituberculous medication. Discussion: The mortality rate among this population of patients with tuberculosis far exceeds that in the UK. Sadly a lake of resources, HIV coinfection and high rate of drug resistance (10% MDR rate) conspire to make TB a challenging disease to treat in this area of South Africa.