The Survival and HIV Outcomes in MDR TB Study

The Survival and HIV Outcomes in MDR TB Study (SHOUT) was a prospective cohort study of patients with multidrug-resistant tuberculosis (MDR TB) comparing treatment outcomes and adverse events in patients with and without HIV co-infection. We enrolled 206 participants ≥18 years of age with culture-confirmed MDR TB who were initiating therapy between 2011 and 2013. Participants were recruited from three TB referral hospitals in KwaZulu-Natal province, South Africa. Study participants were seen monthly for the duration of therapy (typically 24 months) and quarterly for one year following treatment completion. Each month, participants were interviewed regarding symptoms, adverse events, and medication adherence. Sputum samples were sent monthly for smear microscopy, culture, and drug-susceptibility testing as was routine blood testing. Pure tone audiometry and color vision testing was also performed at regular intervals. The SHOUT Study was the first prospective cohort study to show that—despite the increased pill burden associated with concurrent treatment of HIV and MDR TB—co-infected patients did not generally experience more adverse events or worse treatment outcomes. Selected publications: • Primary treatment outcomes: DOI: 10.1093/cid/cix1125 • Adverse events: DOI: 10.1097/QAI.0000000000002190 • Treatment adherence: DOI: 10.1097/QAI.0000000000002120