Characteristics and Outcomes of a Population of Tuberculosis Inpatients in Lilongwe, Malawi Mina Hosseinipour, MD, MPH Clinical Director UNC Project Lilongwe, Malawi

Background and Methods No TB drug resistance data using Molecular Drug Susceptibility Testing exists in Malawi. WHO estimates for Malawi suggest MDR prevalence of 7.7% (0-18.1) among retreatment patients. Study design: Prospective, observational cohort study of adult, primarily retreatment cases, Tuberculosis inpatients at the Bwaila TB ward in Lilongwe Malawi. – Follow-up of 2 months for retreatment patients – Follow-up of 2 weeks for first treatment Procedures – Demographic and clinical questionnaires – Chest X-ray – HIV status, CD4 and HIVRNA (if HIV infected) TB laboratory (Baseline) – Auramine-O smear fluorescent microscopy, – Culture: LJ (standard of care) and MGIT culture – Drug sensitivity assays (Genotype® MTBDR and direct susceptibility testing)

Enrollment and Drug Resistance Profiles 88 TB inpatients enrolled: – 88% re-treatment, – 42% smear positive – 93% pulmonary TB – 74% HIV co-infected 38/88 (43%) MGIT and 28 (32%) LJ cultures were positive at baseline with a mean time to positivity of 12.1 (Range 1- 42) and 21.5 (Range 7-58) days, respectively. Estimated MDR prevalence: 4% – 3 MDRTB identified /77 retreatment cases Only 1/3 (33%) MDRTB patients was identified with LJ at baseline. No XDR-TB was detected with Hain Genotype® MTBDRsl. All MDR cases started second line TB therapy in mean of 7 days.

Vital Outcomes and Conclusions Vital Outcomes: Five patients (6%) died through 8 weeks of follow-up 3/77 (4%) retreatment 2/11 (18%) first treatment Lower mean hemoglobin at admission was associated with mortality: 10.5 vs. 7.5; p<0.01; CI No association by MDR status, smear status, HIV status Conclusions The MDRTB burden among retreatment patients approximates WHO estimates. MDRTB patients are not routinely identified with sputum smear or LJ. More efficient TB culture and drug susceptibility profiling technology should be adopted.