Original Research

A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape

Lucia J. Stevenson, Leigh Biagio-de Jager, Marien A. Graham, De Wet Swanepoel
South African Journal of Communication Disorders | Vol 69, No 1 | a886 | DOI: https://doi.org/10.4102/sajcd.v69i1.886 | © 2022 Lucia J. Stevenson, Leigh Biagio-de Jager, Marien A. Graham, De Wet Swanepoel | This work is licensed under CC Attribution 4.0
Submitted: 09 December 2021 | Published: 31 March 2022

About the author(s)

Lucia J. Stevenson, Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
Leigh Biagio-de Jager, Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
Marien A. Graham, Department of Science, Mathematics and Technology Education, Faculty of Education, University of Pretoria, Pretoria, South Africa
De Wet Swanepoel, Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa; and, Ear Science Institute Australia, Perth, Australia


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Abstract

Background: South Africa has a high burden of drug-resistant tuberculosis (DRTB) and until recently, ototoxic aminoglycosides were predominant in treatment regimens. Community-based ototoxicity monitoring programmes (OMPs) have been implemented for early detection of hearing loss and increased patient access.

Objectives: A longitudinal study was conducted to describe the service delivery characteristics of a community-based OMP for DRTB patients facilitated by CHWs as well as observed ototoxic hearing loss in this population.

Method: A descriptive retrospective record review of longitudinal ototoxicity monitoring of 194 DRTB patients undergoing treatment at community-based clinics in the city of Cape Town between 2013 and 2017.

Results: Follow-up rates between consecutive monitoring assessments reached as high as 80.6% for patients assessed by CHWs. Few patients (14.2% – 32.6%) were assessed with the regularity (≥ 6 assessments) and frequency required for effective ototoxicity monitoring, with assessments conducted, on average, every 53.4–64.3 days. Following DRTB treatment, 51.5% of patients presented with a significant ototoxic shift meeting one or more of the American Speech-Language-Hearing Association (ASHA) criteria. Deterioration in hearing thresholds was bilateral and most pronounced at high frequencies (4 kHz – 8 kHz). The presence of pre-existing hearing loss, human immunodeficiency virus co-infection and a history of noise exposure were significant predictors of ototoxicity in patients.

Conclusion: DRTB treatment with kanamycin resulted in significant deterioration of hearing longitudinally, predominantly at high frequencies. With ongoing training and supportive supervision, CHWs can facilitate community-based ototoxicity monitoring of DRTB patients. Current protocols and guidelines may require reassessment for appropriate community-based ototoxicity monitoring.


Keywords

community-based services; community health workers; decentralised services; tuberculosis; drug-resistant tuberculosis; hearing loss; ototoxicity monitoring; audiometry; South Africa

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