Stevenson Lucia J, Biagio-de Jager Leigh, Graham Marien A, Swanepoel De Wet
Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria.
S Afr J Commun Disord. 2022 Mar 31;69(1):e1-e13. doi: 10.4102/sajcd.v69i1.886.
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.
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.
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.
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.
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.
南非耐多药结核病（DRTB）负担沉重，直到最近，耳毒性氨基糖苷类药物在治疗方案中仍占主导地位。已实施基于社区的耳毒性监测项目（OMPs），以早期发现听力损失并增加患者就诊机会。
开展一项纵向研究，描述由社区卫生工作者（CHWs）推动的针对DRTB患者的基于社区的OMP的服务提供特征，以及该人群中观察到的耳毒性听力损失情况。
对2013年至2017年期间在开普敦市社区诊所接受治疗的194例DRTB患者进行耳毒性纵向监测的描述性回顾性记录审查。
由CHWs评估的患者在连续监测评估之间的随访率高达80.6%。很少有患者（14.2% - 32.6%）按照有效耳毒性监测所需的规律性（≥6次评估）和频率进行评估，评估平均每53.4 - 64.3天进行一次。DRTB治疗后，51.5%的患者出现符合美国言语 - 语言 - 听力协会（ASHA）一项或多项标准的显著耳毒性变化。听力阈值恶化是双侧的，在高频（4kHz - 8kHz）最为明显。既往存在听力损失、人类免疫缺陷病毒合并感染和噪声暴露史是患者耳毒性的重要预测因素。
用卡那霉素治疗DRTB导致听力纵向显著恶化，主要发生在高频。通过持续培训和支持性监督，CHWs可以推动对DRTB患者进行基于社区的耳毒性监测。当前的方案和指南可能需要重新评估，以进行适当的基于社区的耳毒性监测。
