Aminoglycoside-induced Hearing Loss Among Patients Being Treated for Drug-resistant Tuberculosis in South Africa: A Prediction Model

Abstract Background Individuals treated for drug-resistant tuberculosis (DR-TB) with aminoglycosides (AGs) in resource-limited settings often experience permanent hearing loss, yet there is no practical method to identify those at higher risk. We sought to develop a clinical prediction model of AG-induced hearing loss among patients initiating DR-TB treatment in South Africa. Methods Using nested, prospective data from a cohort of 379 South African adults being treated for confirmed DR-TB with AG-based regimens we developed the prediction model using multiple logistic regression. Predictors were collected from clinical, audiological, and laboratory evaluations conducted at the initiation of DR-TB treatment. The outcome of AG-induced hearing loss was identified from audiometric and clinical evaluation by a worsened hearing threshold compared with baseline during the 6-month intensive phase. Results Sixty-three percent of participants (n = 238) developed any level of hearing loss. The model predicting hearing loss at frequencies from 250 to 8000 Hz included weekly AG dose, human immunodeficiency virus status with CD4 count, age, serum albumin, body mass index, and pre-existing hearing loss. This model demonstrated reasonable discrimination (area under the receiver operating characteristic curve [AUC] = 0.71) and calibration (χ2[8] = 6.10, P = .636). Using a cutoff of 80% predicted probability of hearing loss, the positive predictive value of this model was 83% and negative predictive value was 40%. Model discrimination was similar for ultrahigh-frequency hearing loss (frequencies >9000 Hz; AUC = 0.81) but weaker for clinically determined hearing loss (AUC = 0.60). Conclusions This model may identify patients with DR-TB who are at highest risk of developing AG-induced ototoxicity and may help prioritize patients for AG-sparing regimens in clinical settings where access is limited.

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Prevalence of Pre-Existing Hearing Loss Among Patients With Drug-Resistant Tuberculosis in South Africa

American Journal of Audiology ◽

10.1044/2020_aja-19-00103 ◽

2020 ◽

Vol 29 (2) ◽

pp. 199-205

Author(s):

Hyejeong Hong ◽

David W. Dowdy ◽

Kelly E. Dooley ◽

Howard W. Francis ◽

Chakra Budhathoki ◽

...

Keyword(s):

South Africa ◽

Hearing Loss ◽

Statistical Significance ◽

Prior History ◽

Drug Resistant ◽

Second Line ◽

Cross Sectional ◽

Drug Resistant Tuberculosis ◽

Tb Treatment ◽

Resistant Tuberculosis

Purpose Hearing loss, resulting from aminoglycoside ototoxicity, is common among patients with drug-resistant tuberculosis (DR-TB). Those with pre-existing hearing loss are at particular risk of clinically important hearing loss with aminoglycoside-containing treatment than those with normal hearing at baseline. This study aimed to identify factors associated with pre-existing hearing loss among patients being treated for DR-TB in South Africa. Method Cross-sectional analysis nested within a cluster-randomized trial data across 10 South African TB hospitals. Patients ≥ 13 years old received clinical and audiological evaluations before DR-TB treatment initiation. Results Of 936 patients, average age was 35 years. One hundred forty-two (15%) reported pre-existing auditory symptoms. Of 482 patients tested by audiometry, 290 (60%) had pre-existing hearing loss. The prevalence of pre-existing hearing loss was highest among patients ≥ 50 years (adjusted prevalence ratio [aPrR] for symptoms 5.53, 95% confidence interval (CI) [3.63, 8.42]; aPrR for audiometric hearing loss 1.63, 95% CI [1.31, 2.03] compared to age 13–18 years) and among those with a prior history of second-line TB treatment (aPrR for symptoms 1.73, 95% CI [1.66, 1.80]; PrR for audiometric hearing loss 1.33, 95% CI [1.03, 1.73]). Having HIV with cluster of differentiation 4 cell count < 200 cells/mm 3 and malnutrition were risk factors but did not reach statistical significance in adjusted analyses. Conclusion Pre-existing hearing loss is common among patients presenting for DR-TB treatment in South Africa, and those older than the age of 50 years or who had prior second-line TB treatment history were at highest risk.

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Hearing loss among patients on treatment for drug-resistant tuberculosis in Uganda

South Sudan Medical Journal ◽

10.4314/ssmj.v14i3.3 ◽

2021 ◽

Vol 14 (3) ◽

pp. 80-84

Author(s):

Lodiong Jackson Dumo Lodiong ◽

Timbine Amos ◽

Boniface Amanee Elias Lumori ◽

Edwin Nuwagira

Keyword(s):

Hearing Loss ◽

Cox Model ◽

Hearing Threshold ◽

P Value ◽

Drug Resistant ◽

Treatment Unit ◽

Drug Resistant Tuberculosis ◽

Regional Referral Hospital ◽

Resistant Tuberculosis ◽

Male Sex

Introduction: Second-line injectable therapy using aminoglycosides (AG) like kanamycin, amikacin or capreomycin is associated with irreversible hearing loss. We aimed to determine the incidence and predictors of hearing loss among patients with drug resistant tuberculosis (DR-TB) who received AG.Method: This was a retrospective cohort study conducted at the tuberculosis treatment unit of Mbarara Regional Referral Hospital (MRRH). All adult patients with a diagnosis of DR-TB between March 2016 and December 2019 were candidates for inclusion in the study. Hearing loss was defined as a hearing threshold of >20 decibels (dB) at any test frequency in at least one ear. The incidence and predictors of hearing loss were analysed using multivariable Cox model. A p-value of ≤0.05 was considered as statistically significant. Data analysis was done using STATA version 13.Results: The estimated rate of developing hearing loss was 107 per 1000 person months. Thirty-seven (52.9%) of 70 DR-TB patients experienced some degree of hearing loss, of which 25 (67.6 %) developed mild, 5 (13.5%) moderate, and 3 (8.1%) severe hearing loss. Male sex (HR 2.05, CI 1.03-4.10, p-value 0.041), increasing age (HR.5.17, CI 1.42-18.87, p-value 0.013) and high BMI (HR 3.31, CI 1.15 - 9.53, p-value 0.026) were significant predictors of new onset of hearing loss.Conclusion: The incidence of hearing loss among DR-TB patients was high, with the majority having a mild hearing loss. Patients who were male, older, overweight and/or obese were more likely to develop AG-induced hearing loss.

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Clinical Guidelines for Managing Hearing Loss as a Complication of Drug-Resistant Tuberculosis Treatment: An Evaluation of Implementation fidelity in Kano, Nigeria

10.21203/rs.3.rs-654798/v1 ◽

2021 ◽

Author(s):

Sani Ibrahim Muhammad ◽

Ejemai Amaize Eboreime ◽

Vivian Ifeoma Ogbonna ◽

Iliyasu Zubairu ◽

Latifat Ibisomi

Keyword(s):

Hearing Loss ◽

Work Experience ◽

Implementation Fidelity ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Management Guidelines ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Quality Of Delivery

Abstract Background: Nigeria has a high burden of Tuberculosis (TB) including Drug-resistant Tuberculosis (DR-TB) and hearing lossObjective: To measure the implementation fidelity of management guidelines for hearing loss resulting from DR-TB treatment and to identify its determinants Method: A questionnaire-based cross-sectional study was conducted at the Infectious Disease Hospital, Kano. Implementation fidelity of the Programmatic Management guidelines for the treatment of Drug-resistant Tuberculosis was measured under the four domains of content, coverage, duration and frequency. The determinants examined are intervention complexity, facilitation strategies, quality of delivery and participant responsiveness as proposed by the Carroll et al framework. Other determinants used are age, sex, professional cadre and work experience of healthcare providers.Results: The Implementation fidelity score ranged from 40 - 64% with a mean of 47.6%. Quality of delivery, intervention complexity, participants’ responsiveness, and being a medical doctor exerted a positive effect on implementation fidelity while facilitation strategy, age and work experience exerted a negative effect on implementation fidelity. Conclusion: The implementation fidelity of management guidelines for hearing loss resulting from DR-TB treatment was low. Implementation fidelity should be assessed early and at intervals in the course of implementing the PMDT guideline and indeed, in the implementation of any intervention.

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