Stevenson, Lucia JaneBiagio-de Jager, LeighGraham, Marien AletSwanepoel, De Wet2023-02-172023-02-172022-03-31Stevenson, L.J., Biagio-de Jager, L., Graham, M.A., & Swanepoel, D.W. (2022). A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape. South African Journal of Communication Disorders, 69(1), a886. https://DOI.org/10.4102/sajcd.v69i1.886.0379-8046 (print)2225-4765 (online)10.4102/ sajcd.v69i1.886https://repository.up.ac.za/handle/2263/89683BACKGROUND : 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.en© 2022. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.Community-based servicesDecentralised servicesHearing lossOtotoxicity monitoringAudiometryTuberculosis (TB)Drug-resistant tuberculosis (DR-TB)South Africa (SA)Community health worker (CHW)Article