A home-based approach to managing multi-drug resistant tuberculosis in Uganda: a case report

Successful treatment of multi-drug resistant tuberculosis (MDR-TB) in HIV-positive patients is a challenge in resource-limited settings. In Uganda, the exact magnitude of MDR-TB is not known, though a national drug resistance survey is ongoing. To date, there has not been any reported successful treatment of MDR-TB using the home-based approach in East Africa. However, a recent study conducted in South Africa found that a similar approach has been effective [1]. In a first attempt, Mildmay Uganda has successfully treated a patient with MDR-TB using a home-based approach.A 42-year old HIV-positive male, in a discordant relationship, presented to the Mildmay Uganda clinic with a long-standing cough, chest and abdominal pain, night sweats, and impairment of short-term memory. The patient had two previous episodes of pulmonary tuberculosis (TB), and on both occasions, this condition was managed in hospital, and he completed treatment in accordance with the Uganda Ministry of Health TB program standard regimes (2RHZE/6EH and 2RHZES/1RHZE/5RHE) [2]. On examination in March 2007, the patient had consolidation of the upper lobe of the left lung. Investigations showed the sputum ZN smear positive for AFBs (3+). A diagnosis of TB was made, and the patient started TB treatment (2RHEZS/1REHZ/5REH), as per standard guidelines [2]. A sputum sample was sent to the Ugandan National TB laboratory for mycobacterium culture; results indicated innumerable mycobacterium colonies, but unfortunately the laboratory could not perform drug sensitivity tests at that time. Follow-up ZN sputum smears performed 3 months after the patient started treatment were still positive for AFBs.After 8 months on treatment, the patient's sputum was still positive for AFB. In April 2008, sputum cultures were sent to the mycobacteriology laboratory at the Joint Clinical Research Centre in Kampala, and results indicated mycobacterium TB resistant to the following TB drugs: streptomycin, isoniazid, and rifampic