Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria

Tuberculosis treatment outcomes and associated factors at Alemgena Health Center, Sebeta, Oromia, Ethiopia

BACKGROUND

Tuberculosis (TB) is a global public health problem. Evaluation of TB treatment outcome enables health institutions to measure and improve the effectiveness of TB control programs. This study aimed to assess treatment outcomes of tuberculosis and identify associated factors among TB patients registered at Alemgena Health Center, Oromia, Ethiopia.

METHOD

A retrospective study was conducted; Secondary data were collected from medical records of 1010 TB patients treated at Alemgena Health Center between September 2012 and August 2018, inclusively. Logistic regression was used to identify factors associated with TB treatment outcomes. P-value less than 0.05 was considered statistically significant.

RESULTS

The proportion of males and females was almost equal. Among the patients 64.7% were in the age group 15-34, 98% were new cases, 31.2% were smear positive, 13% were HIV positive and 40.3% had extra-pulmonary tuberculosis. 94.2% of the patients had successful treatment outcome, with 26.9% cured and 67.3% treatment completed, whereas 5.8% had unsuccessful treatment outcomes, of whom 4.2% died and 1.5% defaulted. Death rate was higher among patients older than 44 years (10.4%) than among children (0%). In bivariate logistic regression analysis, treatment success rate was 3.582 (95% CI 1.958-6.554, p-value = .000) times higher in the age group 44 and below compared to the age group 45 and above.

CONCLUSION

Treatment success rate exceeded the one targeted by WHO. Age was found to be associated with treatment outcome. Success rate has to be improved for TB patients in the age group greater than 45 years of age.

The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria

BACKGROUND

Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance.

OBJECTIVE

We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received.

METHODS

A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior.

RESULTS

Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications.

CONCLUSIONS

Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance.

Predictors of tuberculosis treatment outcomes among people living with HIV in some States in Nigeria

Introduction

tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major public health threats globally and worse when they co-exist in susceptible individuals. The study examined TB treatment outcomes and their predictive factors among people living with HIV (PLHIVs).

Methods

a review of TB/HIV co-infected patients who had TB treatments across comprehensive antiretroviral therapy (ART) sites with ≥500 patients was conducted in seven United States of America President's Emergency Plan for AIDS Relief (PEPFAR)-supported States in Nigeria. Data on patient background, HIV and TB care, and TB treatment outcomes were collected using an Excel abstraction template. The data was analyzed using SPSS and an association was examined using a chi-square test while binary logistic regression was used to determine predictors of TB treatment outcomes (P< 0.05).

Results

two thousand six hundred and fifty-two co-infected patients participated in the study. The mean age of participants was 37 ± 14 years. A majority had TB treatment success (cured = 1059 (39.9%), completed = 1186 (44.7%)). Participants who had pulmonary TB, virally suppressed and commenced isoniazid (INH) before TB diagnosis were more likely to have a favorable TB treatment outcome compared to those who had extrapulmonary TB (AOR = 7.110, 95% CI = 1.506 - 33.565), virally unsuppressed (AOR = 1.677, 95% CI = 1.036 - 2.716) or did not commence INH before TB diagnosis (AOR = 1.486, 95% CI = 1.047 - 2.109).

Conclusion

site of infection, immune status, exposure to ART, and INH prophylaxis were found to predict TB treatment outcomes among PLHIVs. Stakeholders should ensure early commencement of ART and INH prophylaxis for PLHIVs.

Engagement of private health care facilities in TB management in Lusaka district of Zambia: lessons learned and achievements

BACKGROUND

Globally, at least 3 million TB patients are missed every year. In Zambia, the TB treatment coverage increased from 66% in 2020 to 92% in 2022. Involvement of all levels of health care service delivery is critical to finding all the missing TB patients.

METHODS

A survey was undertaken in 15 private facilities in Lusaka district of Zambia using a structured tool administered by project team and a district health team member. Data collected during the survey was analysed and results were used to determine the type of TB services that were offered as well as barriers and enablers to TB service provision. This was followed by a set of interventions that included; training and mentorship on active case finding and systematic TB screening, increased diagnostic capacity, provision of national recording and reporting tools and provision of TB medication through linkage with the National TB program (NTP). We report findings from the baseline survey and changes in presumptive TB identification and notification following interventions.

RESULTS

Major barriers to TB service delivery were the high cost of TB diagnostic testing and treatment in facilities where services were not supported by the National TB program; the mean cost was 33 (SD 33) and 93 (SD 148) for GeneXpert testing and a full course of treatment respectively. Pre-intervention, presumptive TB identification appeared to increase monthly by 4 (P = 0.000, CI=[3.00-5.00]). The monthly trends of presumptive TB identification during the intervention period increased by 5.32 (P = 0.000, [CI 4.31-6.33. Pre-intervention, the notification of TB appeared to decrease every month by -4.0 (P = 0.114, CI=[-9.00-0.10]) followed by an immediate increase in notifications of 13.94 TB patients (P = 0.001, CI [6.51, 21.36] in the first month on intervention. The monthly trends of notification during the intervention period changed by 0.34 (P = 0.000 [CI 0.19-0.48]). Private facility contribution to TB notification increased from 3 to 7%.

CONCLUSION

Engagement and inclusion of private health facilities in TB service provision through a systems strengthening approach can increase contribution to TB notification by private health facilities.

Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study

OBJECTIVES

This study aimed to assess the practices of private practitioners regarding tuberculosis (TB), and to ascertain factors related to the low contribution of private healthcare providers to TB prevention and care in Nigeria.

DESIGN

This is a mixed methods study comprising a quantitative retrospective review and qualitative study.

SETTING

Private health facilities (HF) in Oyo State and the Federal Capital Territory (FCT), Nigeria.

PARTICIPANTS

We used routinely collected data on patients with tuberculosis (TB) notified between 1 January 2017 and 31 December 2018. In-depth interviews were also conducted with the clinical staff of the facilities.

PRIMARY AND SECONDARY OUTCOME MEASURES

The study outcomes are practices of TB case notification and treatment outcome, as well as the barriers and enablers of TB notification.

RESULTS

A total of 13 (11.0%) out of 118 private HF were designated as 'engaged' TB care facilities in Oyo State and none (0%) of the 198 private HF in the FCT held this designation. From the 214 patients with presumptive TB, 75 (35%) were diagnosed with TB, 42 (56%) had a bacteriological test done, 12 (16%) had an X-ray of the chest alone and 21 (28%) had other non-specific investigations. Most patients diagnosed were referred to a public HF, while 19 (25%) patients were managed at the private HF. Among them, 2 (10.5%) patients were treated with unconventional regimens, 4 (21%) were cured, 2 (11%) died, 3 (16%) lost to follow-up and 10 (53%) were not evaluated. The general practitioners did not have up-to-date knowledge of TB with a majority not trained on TB. Most referred patients with presumptive and confirmed TB to the public sector without feedback and were unclear regarding diagnostic algorithm and relevant tests to confirm TB.

CONCLUSION

Most private facilities were not engaged to provide TB services although with knowledge and practice gaps. The study has been used to develop plans for strategic engagement of the private sector in Nigeria.

Bibliometric structured review of tuberculosis in Nigeria

Background: The tuberculosis burden is growing in Nigeria along with its population. For example, Nigeria has the sixth highest TB burden globally, with an estimated 4.3 per cent multi-drug resistance in new cases. This study builds on the existing study that examined academic involvement in tuberculosis research. The study in question focused on global medical literature related to tuberculosis, but the non-visibility of some low and middle-income countries in the bigger global picture motivated this present study. Every year, over 245,000 Nigerians succumb to tuberculosis (TB), with approximately 590,000 new cases reported (of these, around 140,000 are also HIV-positive). This study carried out an academic publication evaluation with the VOS viewer tool to map bibliometric data for scholarly articles published between 1991 and 2021 on tuberculosis research and used the Biblioshiny app for analytics and plots of authors, sources, and documents to explore the descriptive statistics of tuberculosis literature. The present study delineates that England has the highest collaborating country with Nigeria in the study of tuberculosis over the years and according to the report, the University of Nigeria, the University of Ibadan, and Nnamdi Azikwe University are Nigerian institutions with extensive collaborations. This study concludes with managerial implications for future actions.

Factors influencing tuberculosis preventive practices among people living with HIV/AIDS enrolled in secondary health facilities in Lagos, Nigeria

Background information

Tuberculosis is the most potent opportunistic infection leading to deaths among patients with Human Immunodeficiency Virus (HIV). Therefore, knowledge, attitude and practices regarding tuberculosis preventive strategy among People Living with HIV/AIDS (PLWHA) is vital in minimizing the risk of developing TB infection which forms the objective of this study.

Methodology

A descriptive cross-sectional study carried out using multi-stage sampling technique in selecting 606 respondents. Data was collected using a semi-structured questionnaire and analysed with SPSS version 23.

Result

Of all the respondents, 245 (40.4%) were within 28-37 years, 386 (63.7%) were females and 219 (36.1%) had secondary education. Majority of the respondents 500 (82.5%), 423(69.8%) and 411(67.8%) had positive attitude, good practices and good knowledge respectively. Associated factors were age, marital status, religion, educational status, knowledge and attitude with tuberculosis practices. Respondents between 18-27 years were twice less likely to engage in good TB preventive practices (OR-0.44, 95% CI- 0.25-0.78, p = 0.004).

Conclusion

Over half of respondents had good tuberculosis preventive practices, influenced by their socio-demographic characteristics, knowledge and attitude towards TB infection. Preventive efforts need to be strengthened among individuals between 18-27 years of age, non-Christians and those with lower educational status.

Exploration of the diversity of multi-drug resistant Mycobacterium tuberculosis complex in Lagos, Nigeria using WGS: Distribution of lineages, drug resistance patterns and genetic mutations

Multidrug-resistant (MDR) or extensively drug-resistant (XDR) Tuberculosis (TB) is a major challenge to global TB control. Therefore, accurate tracing of in-country MDR-TB transmission are crucial for the development of optimal TB management strategies. This study aimed to investigate the diversity of MTBC in Nigeria. The lineage and drug-resistance patterns of the clinical MTBC isolates of TB patients in Southwestern region of Nigeria were determined using the WGS approach. The phenotypic DST of the isolates was determined for nine anti-TB drugs. The sequencing achieved average genome coverage of 65.99X. The most represented lineages were L4 (n = 52, 83%), L1 (n = 8, 12%), L2 (n = 2, 3%) and L5 (n = 1, 2%), suggesting a diversified MTB population. In term of detection of M/XDR-TB, while mutations in katG and rpoB genes are the strong predictors for the presence of M/XDR-TB, the current study also found the lack of good genetic markers for drug resistance amongst the MTBC in Nigeria which may pose greater problems on local tuberculosis management efforts. This high-resolution molecular epidemiological data provides valuable insights into the mechanistic for M/XDR TB in Lagos, Nigeria.

Evaluating determinants of treatment outcomes among tuberculosis patients in the mining district of Butha Buthe, Lesotho

Background

Before the COVID-19 pandemic, tuberculosis (TB) was the leading infectious cause of death globally. In low- and middle-income countries (LMIC) including Lesotho, treatment outcome is lower than the recommended rate and poor TB treatment outcomes remain a programmatic challenge. The aim of this study was to determine unfavourable treatment outcomes and associated risk factors among TB patients in Butha Buthe district.

Methods

This was a retrospective record review of TB patients registered between January 2015 and December 2020. Data were collected from TB registers and patients' files and entered Microsoft Excel 2012. Analysis was conducted using R and INLA statistical software. Descriptive statistics were presented as frequencies and percentages. The differences between groups were compared using Pearson's X 2 test in bivariate analysis. Frailty Cox proportional hazards model was used to determine the risk of unfavourable outcomes among the variables.

Results

A total of 1792 TB patients were enrolled in the study with about 70% males (1,257). Majority (71.7%) of the patients were between 20 and 59 years old, with 48% of the patients being unemployed. Almost a quarter of the patients (23.1%) had unfavourable outcomes with death (342 patients) being the most common unfavourable outcome. Our study has shown that patients older than 59 years, and unemployment increased the risk of having unfavourable treatment outcomes. Death was the most common unfavourable outcome followed by lost-to-follow up. We also observed that the patients in the initiation phase of treatment died at a faster rate compared to those in the continuation phase (p=0.02).

Conclusion

TB treatment programs should have efficient follow-up methods geared more toward elderly patients. Active case finding to identify population at risk should be part of a TB program which would improve early diagnosis and treatment initiation. Patients in the intensive phase of the treatment program should be monitored more closely to determine adverse drug effects and nutritional requirement to prevent death during this phase of treatment.

Tuberculosis treatment outcomes among pulmonary TB patients attending public hospitals in Kebbi State, Northern Nigeria: a four-year retrospective study

BACKGROUND

In Nigeria, effective case management and evaluation of pulmonary tuberculosis treatment outcomes are an integral part of controlling the spread of infectious diseases. The study reviewed the treatment outcomes of pulmonary tuberculosis and the factors associated with rates of successful and unsuccessful treatment outcomes in the 21 referral hospitals in Kebbi State, Nigeria.

METHODS

Documented records of pulmonary tuberculosis patients from January 2018 to December 2021 in 21 Local Area Councils in Kebbi State, Northern Nigeria were reviewed. A structured questionnaire collated the socio-demographic and clinical data from the documented records. Descriptive statistics were used to compute and analyse the outcomes of successful and unsuccessful treatment. Logistic regression models were used to determine the association of socio-demographic and clinical data with the unsuccessful treatment outcomes.

RESULTS

The study reviewed data from 6114 records of TB patients. 1161 (18.9%) started treatment, 963 (82.9%) were males and 198 (17.1%) were females. Of the 1161 patients, 985 (18.2%) had documented treatment outcomes. 932 of 985 (95.1%) had a pulmonary infection. 64 (5.8%) patients with documented treatment outcomes were HIV seropositive. 903 (91.7%) were successfully treated, and 82 (8.3%) failed. Of the patients with failed treatment outcomes, 15 (1.5%) were lost to follow-up, 43 (4.4%) defaulted and 24 (2.4%) died. In the logistic analysis, the odds of unsuccessful treatment outcomes were higher among elderly patients (AOR = 2.00, 95% CI 1.37-2.92), patients with extrapulmonary infections (AOR = 2.40, 95% CI 1.12-5.39), and with old cases of pulmonary TB (AOR = 3.03, 95% CI 1.47-7.19) when compared to their groups.

CONCLUSIONS

The study reported a treatment success rate of 91.7% among TB patients attending public hospitals in Kebbi State. The outcome was higher than the projected success rate of 85% set by the WHO. However, one-fourth of the total patients reviewed were not documented for treatment. Therefore, the need to design an appropriate recruitment strategy to identify and enrol those patients for an effective and successful TB control program in Nigeria.

Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers

Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria's large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical facilities, laboratories, pharmacies, and drug shops it trained to deliver TB services. The study used a standardized patient (SP) survey methodology to measure case management protocol adherence among 837 private and 206 public providers in urban Lagos and Kano. It examined two different scenarios: a "textbook" case of presumptive TB and a treatment initiation case where SPs presented as referred patients with confirmed TB diagnoses. Private sector results were benchmarked against public sector results. A bottleneck analysis examined protocol adherence departures at key points along the case management sequence that providers were trained to follow. Except for laboratories, few providers met the criteria for fully correct management of presumptive TB, though more than 70% of providers correctly engaged in TB screening. In the treatment initiation case 18% of clinical providers demonstrated fully correct case management. Private and public providers' adherence was not significantly different. Bottleneck analysis revealed that the most common deviations from correct management were failure to initiate sputum collection for presumptive patients and failure to conduct sufficiently thorough treatment initiation counseling for confirmed patients. This study found the quality of private providers' TB case management to be comparable to public providers in Nigeria, as well as to providers in other high burden countries. Findings support continued efforts to include private providers in Nigeria's national TB program. Though most providers fell short of desired quality, the bottleneck analysis points to specific issues that TB stakeholders can feasibly address with system- and provider-level interventions.