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Rakotondrasoa SR, Raherinandrasana AH, Ramanarivo N, Ramontalambo TJ, Randriananahirana ZA, Ravaoarisoa L, Rakotonirina J. Predictors of tuberculosis treatment outcomes in Antananarivo: a retrospective cohort study. Pan Afr Med J 2023; 46:104. [PMID: 38435404 PMCID: PMC10908297 DOI: 10.11604/pamj.2023.46.104.41514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/17/2023] [Indexed: 03/05/2024] Open
Abstract
Introduction Tuberculosis (TB) is a global public health issue, affecting Africa and Madagascar. Adverse outcomes following ineffective treatment are common. Previous studies conducted in similar settings have not adequately accounted for confounding factors. The objective of this study is to identify predictive factors that are associated with tuberculosis treatment outcomes in Madagascar. Methods a retrospective cohort study was conducted using registries of 628 outpatients with tuberculosis at the Analakely Hospital (CHUSSPA) in 2019. Univariate and multivariate logistic regression analyses were performed. Results the study included 628 patients with a mean age of 37.19 ± 15.86 years and a sex ratio of 1.57. These patients were followed up for a total of 2886 person-months. Out of the 628, 517 achieved treatment success, while 31 patients died and 31 discontinued their treatment. The rates of treatment success, death, failure, and default were 82.3%, 4.9%, 0.2%, and 8.3% respectively. Female gender was found to be a predictor of treatment success area of responsibility adjusted odds ratio(AOR 1.67 [1.07-2.66]; p=0.026). Smear-negative pulmonary tuberculosis (SNPTB) was associated with a lower likelihood of treatment success (AOR 0.38 [0.23-0.65]; p<0.001) and was a common factor for default (AOR 3.17 [1.60-6.21]; p=0.001) and death (AOR=8.03 [3.01-23.72; p<0.001]). Extra-pulmonary TB was identified as a predictor of death (AOR 5.15 [1.99-14.95]; p=0.001). Conclusion the tuberculosis treatment indicators in this center have not yet met national and global targets. It is necessary to focus on early diagnosis, improving education, and implementing rigorous follow-up procedures for patients at high risk of adverse outcomes (SNPTB and extra-pulmonary tuberculosis(EPTB).
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Affiliation(s)
- Sedera Radoniaina Rakotondrasoa
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar
| | - Antso Hasina Raherinandrasana
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- Hospital for Care and Public Health of Analakely (CHUSSPA), Antananarivo, Madagascar
| | - Norotiana Ramanarivo
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- Hospital for Care and Public Health of Analakely (CHUSSPA), Antananarivo, Madagascar
| | - Tantely Jenny Ramontalambo
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar
| | - Zina Antonio Randriananahirana
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar
| | | | - Julio Rakotonirina
- Faculty of Medicine of Antananarivo, Antananarivo, Madagascar
- National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar
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A Nomogram Model for Mortality Risk Prediction in Pulmonary Tuberculosis Patients Subjected to Directly Observed Treatment Shortcourse (DOTS). Can Respir J 2022; 2022:1449751. [PMID: 36567966 PMCID: PMC9788877 DOI: 10.1155/2022/1449751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
We analyzed the risk factors of mortality for patients with pulmonary tuberculosis under the Directly Observed Treatment Shortcourse (DOTS) and established a predictive nomogram for the risk of mortality. The retrospective cohort analysis was conducted on the treatment outcomes of 11207 tuberculosis patients in the tuberculosis management information system in Tianjin from 2014 to 2019. Based on the multivariable unconditional logistic regression, we analyzed the risk factors of mortality in patients with pulmonary TB and established the death risk prediction nomogram. We further applied cross-validation and the receiver operating characteristic (ROC) curve to explore the efficiency of the nomogram. There were 10,697 patients in the survival group and 510 in the mortality group who had successfully initiated DOTS, and the mortality rate was 4.55%. Multivariable logistic regression analysis showed that age, male, relapse cases, first sputum positivity, patient delay, and HIV-positive were independent risk factors for pulmonary TB death. The calibration curve shows that the average absolute error between the predicted mortality risk and the actual death risk is 0.003. The ROC curve shows that the area under the curve where the line-up model predicts the risk of death is 0.816 (95% CI: 0.799∼0.832). The nomogram model based on independent risk factors of mortality in TB patients shows good discrimination and accuracy, with potentially high clinical value in screening patients with a high risk of death, which could be useful for setting the interventional strategies in patients with tuberculosis who had successfully initiated DOTS.
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Ballayira Y, Yanogo PK, Konaté B, Diallo F, Sawadogo B, Antara S, Méda N. Time and risk factors for death among smear-positive pulmonary tuberculosis patients in the Health District of commune VI of Bamako, Mali, 2016. BMC Public Health 2021; 21:942. [PMID: 34006238 PMCID: PMC8132441 DOI: 10.1186/s12889-021-10986-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background The End Tuberculosis (TB) Strategy aims to achieve 90% reduction of deaths due to TB by 2030, compared with 2015. Mortality due to tuberculosis in Mali was 13 per 100,000 inhabitants in 2014 and 11 per 100,000 inhabitants in 2017. Risk factors for death are not known. The objective of this study was to determine the time and risk factors for death in pulmonary TB patients with positive microscopy. Methods We conducted a retrospective cohort study from October to December 2016 in Commune VI of Bamako. Smear positive cases pulmonary tuberculosis from 2011 to 2015 were included. We reviewed the treatment registers and collected sociodemographic, clinical, biological and therapeutic data. Median time to death and hazard ratio (HR) were estimated by the Kaplan-Meier method and a Cox regression model, respectively. Results In total, we analysed 1362 smear positive cases of pulmonary TB including 104 (8%) HIV positive and 90 (7%) deaths. The mean age was 36 ± 13 years, the sex ratio of males to females was 2:1. Among the deaths, 48 (53%) occurred during the first 2 months of treatment. Age ≥ 45 years (HR 2.09 95% CI [1.35–3.23]), weight < 40 kg (HR 2.20 95% CI [1.89–5.42]), HIV unknown status (HR 1.96, 95% CI [1.04–3.67]) and HIV-positive (HR 7.10 95% CI [3.53–14.26]) were significantly associated with death. Conclusions The median time to death was 2 months from the start of treatment. Independent risk factors for death were age ≥ 45 years, weight < 40 kg, unknown and positive HIV status. We recommend close monitoring of patients over 45 years, HIV testing in those with unknown status, an adequate care for positive HIV status, as well as a nutritional support for those with weight below 40 kg during the intensive phase of TB treatment.
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Affiliation(s)
- Yaya Ballayira
- Burkina Field Epidemiology Training Program, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Pauline Kiswendsida Yanogo
- Burkina Field Epidemiology Training Program, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso. .,Department of Public Health, Faculty of medicine, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso.
| | - Bakary Konaté
- National Directorate of Health, Ministry of Health, Bamako, Mali
| | - Fadima Diallo
- Burkina Field Epidemiology Training Program, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | | | - Simon Antara
- African Field Epidemiology Network, Kampala, Uganda
| | - Nicolas Méda
- Burkina Field Epidemiology Training Program, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso.,Department of Public Health, Faculty of medicine, University Joseph KI-ZERBO, Ouagadougou, Burkina Faso
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4
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Geleso MG. Modeling the Survival of Tuberculosis Patients in Eastern Zone of Tigray Regional State. Healthc Policy 2020; 13:473-481. [PMID: 32581610 PMCID: PMC7274535 DOI: 10.2147/rmhp.s251376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/09/2020] [Indexed: 01/25/2023] Open
Abstract
Background Tuberculosis (TB) is still a public health problem and amongst the top ten leading causes of death. The aim of this paper was to identify the factors that significantly affect the survival of tuberculosis patients. Methods A retrospective cohort study was carried out in Adigrat General and Wukro hospitals, Eastern Zone of Tigray region, Ethiopia. Data for this study were obtained from medical records of all TB cases registered from September 2016 to August 2017 in the two hospitals. Log-rank test and Kaplan–Meier plot were used to evaluate the survival pattern of TB patients. A multivariable Cox proportional regression model was employed to identify the predictors of mortality. Factors with a P-value smaller than 0.05 were taken as statistically significant facilitators of TB death. Results Of the 397 patients studied over the specified period, 23 (5.8%) had died. A statistically significant survival difference was observed among gender, residence, HIV status, treatment category, and age category of patients. In multivariable cox regression, lower survival rates were observed among patients aged ≥45 years (HR = 5.315, 95% CI: 1.231–22.959), relapse cases (HR = 4.069, 95% CI: 1.636–10.119), patients with extrapulmonary TB (HR = 3.054, 95% CI: 1.044–8.940), patients from rural areas (HR = 2.834, 95% CI: 1.161–6.916), patients with a bodyweight of ≤50 kg and HIV-positive patients. Conclusion Based on the survival experience of TB patients, advancing age, extrapulmonary TB infection, living in rural residence, lower bodyweight at beginning of treatment, HIV co-infection, and being a retreatment patient were predictors of mortality. To achieve the “End TB Strategy” goal of zero death, proper targeting of care to these vulnerable groups should be advised.
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Humphrey JM, Mpofu P, Pettit AC, Musick B, Carter EJ, Messou E, Marcy O, Crabtree-Ramirez B, Yotebieng M, Anastos K, Sterling TR, Yiannoutsos C, Diero L, Wools-Kaloustian K. Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium. Open Forum Infect Dis 2020; 7:ofaa006. [PMID: 32010735 PMCID: PMC6984675 DOI: 10.1093/ofid/ofaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background In resource-constrained settings, many people with HIV (PWH) are treated for tuberculosis (TB) without bacteriologic testing. Their mortality compared with those with bacteriologic testing is uncertain. Methods We conducted an observational cohort study among PWH ≥15 years of age initiating TB treatment at sites affiliated with 4 International epidemiology Databases to Evaluate AIDS consortium regions from 2012 to 2014: Caribbean, Central and South America, and Central, East, and West Africa. The exposure of interest was the TB bacteriologic test status at TB treatment initiation: positive, negative, or no test result. The hazard of death in the 12 months after TB treatment initiation was estimated using a Cox proportional hazard model. Missing covariate values were multiply imputed. Results In 2091 PWH, median age 36 years, 53% had CD4 counts ≤200 cells/mm3, and 52% were on antiretroviral therapy (ART) at TB treatment initiation. The adjusted hazard of death was higher in patients with no test compared with those with positive test results (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.08–2.26). The hazard of death was also higher among those with negative compared with positive tests but was not statistically significant (HR, 1.28; 95% CI, 0.91–1.81). Being on ART, having a higher CD4 count, and tertiary facility level were associated with a lower hazard for death. Conclusions There was some evidence that PWH treated for TB with no bacteriologic test results were at higher risk of death than those with positive tests. Research is needed to understand the causes of death in PWH treated for TB without bacteriologic testing.
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Affiliation(s)
- John M Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Philani Mpofu
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - April C Pettit
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Tuberculosis Center, Nashville, Tennessee, USA
| | - Beverly Musick
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - E Jane Carter
- Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Eugène Messou
- University of Bordeaux, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,Centre de Prise en Charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire
| | - Olivier Marcy
- University of Bordeaux, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Marcel Yotebieng
- The Ohio State University, College of Public Health, Columbus, Ohio, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Timothy R Sterling
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Tuberculosis Center, Nashville, Tennessee, USA
| | - Constantin Yiannoutsos
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Lameck Diero
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019; 14:e0226507. [PMID: 31881023 PMCID: PMC6934297 DOI: 10.1371/journal.pone.0226507] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
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Affiliation(s)
- Ninfa Marlen Chaves Torres
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Medicine, Nueva Granada Military University, Bogotá, D.C., Colombia
| | | | | | - María Belen Arriaga
- Gonzalo Moniz Institute, Gonzalo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
| | - Eduardo Martins Netto
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
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Time to death and risk factors among tuberculosis patients in Northern Ethiopia. BMC Res Notes 2018; 11:696. [PMID: 30286801 PMCID: PMC6172746 DOI: 10.1186/s13104-018-3806-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The main objective of this study was to assess time to death and associated risk factors among tuberculosis (TB) patients. RESULTS A total of 769 TB patients were studied and of those, 87 (11.3%) patients died. All of the deaths occurred within 7 months of anti-tuberculosis therapy. Extra-pulmonary TB (AHR = 17.376, 95% CI; 3.88-77.86, p < 0.001) as compared to pulmonary TB and cotrimoxazole prophylaxis therapy (CPT) (AHR = 0.15, 95% CI; 0.03-0.74, p = 0.02) were found to be the predictors of mortality. We noticed higher rates of mortality. Extra-pulmonary TB patients have high risk and TB-HIV co-infected patients who received CPT have low risk of death. Improving early diagnosis of extra-pulmonary TB and early CPT initiation of TB-HIV co-infected patients could minimize patient's mortality.
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Olaleye A, Beke A. Determinants of Survival of Patients with Tuberculosis in Developing Countries. Tuberculosis (Edinb) 2018. [DOI: 10.5772/intechopen.75890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Larsen SE, Baldwin SL, Orr MT, Reese VA, Pecor T, Granger B, Dubois Cauwelaert N, Podell BK, Coler RN. Enhanced Anti- Mycobacterium tuberculosis Immunity over Time with Combined Drug and Immunotherapy Treatment. Vaccines (Basel) 2018; 6:vaccines6020030. [PMID: 29795025 PMCID: PMC6027321 DOI: 10.3390/vaccines6020030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 12/27/2022] Open
Abstract
It is estimated that one third of the world’s population is infected with Mycobacterium tuberculosis (Mtb). This astounding statistic, in combination with costly and lengthy treatment regimens make the development of therapeutic vaccines paramount for controlling the global burden of tuberculosis. Unlike prophylactic vaccination, therapeutic immunization relies on the natural pulmonary infection with Mtb as the mucosal prime that directs boost responses back to the lung. The purpose of this work was to determine the protection and safety profile over time following therapeutic administration of our lead Mtb vaccine candidate, ID93 with a synthetic TLR4 agonist (glucopyranosyl lipid adjuvant in a stable emulsion (GLA-SE)), in combination with rifampicin, isoniazid, and pyrazinamide (RHZ) drug treatment. We assessed the host inflammatory immune responses and lung pathology 7–22 weeks post infection, and determined the therapeutic efficacy of combined treatment by enumeration of the bacterial load and survival in the SWR/J mouse model. We show that drug treatment alone, or with immunotherapy, tempered the inflammatory responses measured in brochoalveolar lavage fluid and plasma compared to untreated cohorts. RHZ combined with therapeutic immunizations significantly enhanced TH1-type cytokine responses in the lung over time, corresponding to decreased pulmonary pathology evidenced by a significant decrease in the percentage of lung lesions and destructive lung inflammation. These data suggest that bacterial burden assessment alone may miss important correlates of lung architecture that directly contribute to therapeutic vaccine efficacy in the preclinical mouse model. We also confirmed our previous finding that in combination with antibiotics therapeutic immunizations provide an additive survival advantage. Moreover, therapeutic immunizations with ID93/GLA-SE induced differential T cell immune responses over the course of infection that correlated with periods of enhanced bacterial control over that of drug treatment alone. Here we advance the immunotherapy model and investigate reliable correlates of protection and Mtb control.
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Affiliation(s)
- Sasha E Larsen
- Infectious Disease Research Institute, Seattle, WA 98102, USA.
- Department of Global Health, University of Washington, Seattle, WA 98195, USA.
| | - Susan L Baldwin
- Infectious Disease Research Institute, Seattle, WA 98102, USA.
| | - Mark T Orr
- Infectious Disease Research Institute, Seattle, WA 98102, USA.
- Department of Global Health, University of Washington, Seattle, WA 98195, USA.
| | - Valerie A Reese
- Infectious Disease Research Institute, Seattle, WA 98102, USA.
| | - Tiffany Pecor
- Infectious Disease Research Institute, Seattle, WA 98102, USA.
| | - Brian Granger
- Infectious Disease Research Institute, Seattle, WA 98102, USA.
| | | | - Brendan K Podell
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA.
| | - Rhea N Coler
- Infectious Disease Research Institute, Seattle, WA 98102, USA.
- Department of Global Health, University of Washington, Seattle, WA 98195, USA.
- PAI Life Sciences Inc., Seattle, WA 98102, USA.
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Gebreegziabher SB, Bjune GA, Yimer SA. Total Delay Is Associated with Unfavorable Treatment Outcome among Pulmonary Tuberculosis Patients in West Gojjam Zone, Northwest Ethiopia: A Prospective Cohort Study. PLoS One 2016; 11:e0159579. [PMID: 27442529 PMCID: PMC4956157 DOI: 10.1371/journal.pone.0159579] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/04/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND delay in diagnosis and treatment of tuberculosis (TB) may worsen the disease, increase mortality and enhance transmission in the community. This study aimed at assessing the association between total delay and unfavorable treatment outcome among newly diagnosed pulmonary TB (PTB) patients. METHODS A prospective cohort study was conducted in West Gojjam Zone, Amhara Region of Ethiopia from October 2013 to May 2015. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study from 30 randomly selected public health facilities. Total delay (the time period from onset of TB symptoms to first start of anti-TB treatment) was measured. Median total delay was calculated. Mixed effect logistics regression was used to analyze factors associated with unfavorable treatment outcome. RESULTS Seven hundred six patients were enrolled in the study. The median total delay was 60 days. Patients with total delay of > 60 days were more likely to have unfavorable TB treatment outcome than patients with total delay of ≤ 60 days (adjusted odds ratio [AOR], 2.33; 95% confidence interval [CI], 1.04-5.26). Human immunodeficiency virus (HIV) positive TB patients were 8.46 times more likely to experience unfavorable treatment outcome than HIV negative TB patients (AOR, 8.46; 95% CI, 3.14-22.79). CONCLUSIONS Long total delay and TB/HIV coinfection were associated with unfavorable treatment outcome. Targeted interventions that can reduce delay in diagnosis and treatment of TB, and early comprehensive management of TB/HIV coinfection are needed to reduce increased risk of unfavorable treatment outcome.
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Affiliation(s)
- Senedu Bekele Gebreegziabher
- Amhara Regional State Health Bureau, Bahir Dar, Ethiopia
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar Aksel Bjune
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Amhara Regional State Health Bureau, Bahir Dar, Ethiopia
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
- Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
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