Treatment Outcomes of Tuberculosis Retreatment Case and Its Determinants in West Ethiopia

Impact of HIV coinfection on tuberculosis treatment outcomes in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Despite the implementation of a short-term direct observation treatment programme, HIV coinfection is one of the main determinants of tuberculosis (TB) treatment success. This meta-analysis was conducted to report the impact of HIV on TB treatment outcomes using inconsistent and variable study findings.

DESIGN

Systematic review and meta-analysis was performed.

DATA SOURCES

The PubMed/Medline, Web of Science and Google Scholar databases were used to access the articles. The Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument was used for the critical appraisal.

ELIGIBILITY CRITERIA

All observational studies conducted in Ethiopia and reporting TB treatment outcomes in relation to HIV coinfection were included in the final analysis.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted the data using a standardised data extraction format. The JBI critical appraisal tool was used to assess the quality of primary studies. Stata V.14 was used for the data analysis. Cochran's Q statistic with inverse variance (I2) and funnel plot are used to assess the presence of heterogeneity (I2=94.4%, p<0.001) and publication bias, respectively. A random effect model was used to estimate TB treatment outcomes with a 95% CI.

RESULTS

The overall success rate of TB treatment was 69.9% (95% CI 64% to 75%). The cure rate of TB among patients living with HIV was 19.3%. Furthermore, the odds of unsuccessful treatment among TB-HIV coinfected patients were 2.6 times greater than those among HIV nonreactive patients (OR 2.65; 95% CI 2.1 to 3.3).

CONCLUSION

The success of TB treatment among patients living with HIV in Ethiopia was lower than the WHO standard threshold (85%). HIV coinfection hurts TB treatment success. Therefore, collaborative measurements and management, such as early treatment initiation, follow-up and the management of complications, are important.

Analysis of the Outcomes of Tuberculosis Treatment and Factors Associated with Successful Treatment at the Bamenda Regional Hospital: A 10-year Retrospective Study

BACKGROUND

Tuberculosis (TB) remains a global public health issue, impacting millions of people worldwide. This study determined the outcomes of TB treatment managed within a 10 year period at the Bamenda Regional Hospital in Cameroon.

METHODS

A retrospective study was carried out among 2428 patients diagnosed and treated for active TB infection from 2013 to 2022, at the Bamenda Regional Hospital. Data collection was done from March to April 2023 using a data extraction form. Bivariate and multivariate logistic regression models were used to identify factors associated with successful TB treatment outcomes. Data was analyzed using SPSS software version 26.

RESULTS

Of the 2428 patients with TB, 1380 (56.8%) were cured, 739 (30.4%) completed treatment, treatment failures were recorded in 10 (0.4%) patients, and 200 (8.2%) died during or after receiving treatment. Treatment default was the outcome in 99 (4.1%). Successful treatment outcomes were reported in 2119 (87.3%). Patients within age groups 41-50 (P = 0.010), 51-60 (P = 0.041), and >60 years (P = 0.006), male (P = 0.004), and human immunodeficiency virus-positive patients (P < 0.001) had decreased odds of successful treatment outcomes.

CONCLUSION

The outcomes of treatment within a 10 year period showed that the treatment success was 2.7% below the World Health Organizations target. Prioritizing vulnerable patient groups in TB management and implementing public health interventions such as financial assistance and nutritional support will go a long way in improving treatment outcomes.

Incidence and predictors of treatment interruption among patients on anti-tuberculosis treatment in Nekemte public healthcare facilities, Oromia, Western Ethiopia

Introduction

Tuberculosis treatment interruption increases the risk of poor treatment outcomes and the occurrence of drug resistant Tuberculosis. However, data on the incidence and predictors of tuberculosis treatment interruption are still scarce in Ethiopia, as well as in the study area. Therefore, this study aimed to assess the incidence and predictors of treatment interruption among patients on tuberculosis treatment in Nekemte public healthcare facilities, Oromia region, Western Ethiopia, from July 1, 2017, to June 30, 2021.

Methods

A retrospective cohort study design was conducted among 800 patients enrolled in anti-tuberculosis treatment during the study period. Data were collected from patient cards who were enrolled in treatment from July 1, 2017 to June 30, 2021. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A multivariable Cox regression model with a 95% confidence interval (CI) and adjusted hazard ratio (AHR) was used to identify the significant predictors at a p value < 0.05. Finally, the log likelihood ratio, and a Cox-Snell residual graph was used to check the adequacy of the model.

Results

A total of 800 patients were followed for a median time of 2.3 (95% CI: 2.20-2.36) months, and with a maximum follow-up time of 11.7 months. The overall incidence rate of treatment interruption was 27.4 per 1000 (95% CI: 22.8-32.8) person-month observations. Age 18-34 years (AHR = 1.8, 95% CI: 1.02-3.18), male (AHR = 1.63, 95% CI: 1.1-2.42), rural residence (AHR = 3, 95% CI: 1.98-4.64), presence of comorbidity (AHR = 10, 95% CI: 5.47-18.27) and lack of treatment supporters on the treatment follow-up (AHR = 2.82, 95% CI: 1.9-4.41) were found to be significant predictors of treatment interruption.

Conclusion

A high incidence rate of interruption was observed among TB patients in public health facilities in Nekemte town. Health facilities should provide supportive care for patients with co-morbidities and consider interventions that target middle-aged patients from rural areas that reduce treatment interruptions.

Low treatment success rate among previously treated persons with drug-susceptible pulmonary tuberculosis in Kampala, Uganda

Rationale

In 2017, the treatment regimen for previously treated persons with tuberculosis (TB) changed to a shorter regimen that lasts six months and consists of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol. Few studies have examined treatment success rate (TSR) among previously treated persons with TB including the associated factors.

Objective

To determine TSR and the associated factors among previously treated persons with bacteriologically confirmed pulmonary TB on a six-month treatment regimen in Kampala, Uganda.

Methods

We retrieved data (January 2012 and December 2021) across six TB clinics in the Kampala Metropolitan area for all previously treated persons with bacteriologically confirmed pulmonary TB. TSR was defined as cure or treatment completion. Frequencies and percentages for categorical data, and the mean and standard deviation for numerical data were computed. Multivariable modified Poisson regression analysis was performed to identify factors associated with TSR, reported as adjusted risk ratio (aRR) with a 95% confidence interval (CI).

Measurements and main results

We enrolled 230 participants with a mean age of 34.8±10.6 years. TSR was 52.2% and was associated with Mycobacterium tuberculosis (MTB) sputum smear load of ≥2+ (1-10 or >10 Acid Fast Bacilli (AFB)/Field) (aRR = 0.51; 95% CI, 0.38-0.68), TB/human immunodeficiency virus (HIV) (aRR = 0.67; 95% CI, 0.51-0.88) or unknown HIV serostatus (aRR = 0.42; 95% CI, 0.26-0.68), and digital community-based directly observed therapy short-course (DOTS) (aRR = 0.42; 95% CI, 0.20-0.88).

Conclusions

The TSR among previously treated persons with bacteriologically confirmed pulmonary TB on a six-month treatment regimen is suboptimal. TSR is less likely for people with TB/HIV co-infection or unknown HIV serostatus, high MTB sputum smear load, and on digital community-based DOTs. We recommend strengthening of TB/HIV collaborative activities and people with TB with high MTB sputum smear load should receive targeted treatment support, and the contextual barriers to digital community DOTS should be addressed.

Diagnosis and Management of Adult Tuberculosis Patients Admitted to a Rural Hospital in Ethiopia

Background  Ethiopia is one of the countries in the world with the highest rate of tuberculosis (TB). The aim of this study is to describe the characteristics of the patients with TB admitted to a rural hospital in Ethiopia in terms of both diagnosis and clinical management. Methods A retrospective descriptive observational study was conducted. Data were collected from patients older than 13 years who were admitted to the Gambo General Hospital for TB between May 2016 and September 2017. The variables studied were age, sex, symptoms, human immunodeficiency virus (HIV) serology, nutritional status, presence of anemia, chest x-ray or other complementary tests, type of diagnosis (smear microscopy, Xpert MTB-RIF (Cepheid, Sunnyvale, California, USA), or clinical diagnosis), treatment received, outcome, and days of admission. Results One hundred eighty-six patients, aged 13 years and older, were admitted to the TB unit. About 51.6% were female, and the median age was 35 years (interquartile range (IQR) 25-50). Cough was the most frequent symptom on admission (88.7%), and contact with a TB patient was only recognized by 22 patients (11.8%). HIV serology was performed in 148 patients (79.6%); seven were positive (4.7%). About 69.3% met the criteria for malnutrition (body mass index (BMI) <18.5). Most patients, 173 (93%), presented with pulmonary TB and were new cases (94.1%). Patients were diagnosed by clinical parameters in 75% of cases. Smear microscopy was performed in 148 patients, of which 46 (31.1%) were positive, and Xpert MTB-RIF results were only obtained in 16 patients, of which 6 (37.5%) were positive. Chest x-rays were performed in most patients (71%) and were suggestive of TB in 111 (84.1%). The average length of hospital stay was 32 days (confidence interval (CI) 13-50.5). Women tend to be younger than men, have more extrapulmonary TB, and were admitted longer. Nineteen patients died during admission (10.2%). Patients who die were more frequently malnourished (92.9% of those who die were malnourished compared to 67.1% of those who did not die, p = 0.036), tend to be admitted for a shorter time than the survivors and receive more concomitant antibiotic treatment. Conclusions In this rural Ethiopian setting, patients admitted to the hospital for TB are often malnourished (67.1%), the main presentation is pulmonary, mortality is one in 10 admissions and very often receive antibiotics in association with TB treatment (40%).

Identification of Mycobacterium tuberculosis in pulmonary and extrapulmonary specimens of Iranian hospitalized patients during 2017-2021

Background

Tuberculosis (TB) is one of the most serious public health problems worldwide which is a chronic infectious disease and is still one of the major challenges for developing countries. This study was undertaken to identify Mycobacterium TB (MTB) in clinical specimens in hospitalized patients.

Methods

The study was carried out on specimens from pulmonary and extrapulmonary suspected TB patients that were admitted to one of the largest tertiary hospitals located in Tehran, Iran from 2017 to 2021. The GeneXpert MTB/rifampin (RIF) method was applied to detect MTB and RIF resistance. Characteristics of demography, clinical features, and lifestyle were obtained from medical case records registered in the hospital.

Results

Of 957 specimens, 92 (9.61%) were found positive for TB by GeneXpert assay. Of positive samples, 72 (78.26%) were considered pulmonary TB, and 20 (21.73%) of them are associated with extrapulmonary involvement. Four (4.3%) positive TB cases were categorized as rifampicin-resistant.

Conclusion

This study showed a relatively high incidence rate of TB in distinct types of specimens in Iranian hospitalized patients but a low level of RIF resistance.

The Performance of Computer-Aided Detection Digital Chest X-ray Reading Technologies for Triage of Active Tuberculosis Among Persons With a History of Previous Tuberculosis

BACKGROUND

Digital chest X-ray (dCXR) computer-aided detection (CAD) technology uses lung shape and texture analysis to determine the probability of tuberculosis (TB). However, many patients with previously treated TB have sequelae, which also distort lung shape and texture. We evaluated the diagnostic performance of 2 CAD systems for triage of active TB in patients with previously treated TB.

METHODS

We conducted a retrospective analysis of data from a cross-sectional active TB case finding study. Participants ≥15 years, with ≥1 current TB symptom and complete data on history of previous TB, dCXR, and TB microbiological reference (Xpert MTB/RIF) were included. dCXRs were evaluated using CAD4TB (v.7.0) and qXR (v.3.0). We determined the diagnostic accuracy of both systems, overall and stratified by history of TB, using a single threshold for each system that achieved 90% sensitivity and maximized specificity in the overall population.

RESULTS

Of 1884 participants, 452 (24.0%) had a history of previous TB. Prevalence of microbiologically confirmed TB among those with and without history of previous TB was 12.4% and 16.9%, respectively. Using CAD4TB, sensitivity and specificity were 89.3% (95% CI: 78.1-96.0%) and 24.0% (19.9-28.5%) and 90.5% (86.1-93.3%) and 60.3% (57.4-63.0%) among those with and without previous TB, respectively. Using qXR, sensitivity and specificity were 94.6% (95% CI: 85.1-98.9%) and 22.2% (18.2-26.6%) and 89.7% (85.1-93.2%) and 61.8% (58.9-64.5%) among those with and without previous TB, respectively.

CONCLUSIONS

The performance of CAD systems as a TB triage tool is decreased among persons previously treated for TB.

Relapse or Re-Infection, the Situation of Recurrent Tuberculosis in Eastern China

Purpose

Recurrent tuberculosis (TB) is defined by more than one TB episode per patient and is caused by re-infection with a new Mycobacterium tuberculosis (Mtb) strain or relapse with the previous strain. Recurrence of TB is one important obstacle for End TB strategy in the world and elucidating the triggers of recurrence is important for the current TB control strategy in China. This study aimed to analyze the sources of recurrent TB by the molecular genotyping method.

Method

A population-based surveillance was undertaking on all culture-positive TB cases in Jiangsu province, China from 2013 to 2019. Phenotypic drug susceptibility test (DST) by proportion method and mycobacterial interspersed repetitive units-variable number of tandem repeat (MIRU-VNTR) were adopted for drug resistance and genotype detection.

Results

A total of 1451 culture-positive TB patients were collected and 30 (2.06%, 30/1451) TB cases had recurrent TB episodes. Except 7 isolates were failed during subculture, 23 paired isolates were assessed. After genotyping by MIRU-VNTR, 12 (52.17%, 12/23) paired recurrence TB were demonstrated as relapse and 11 (47.83%,11/23) paired cases were identified as re-infection. The average interval time for recurrence was 24.04 (95%CI: 19.37-28.71) months, and there was no significant difference between relapse and re-infection. For the relapsed cases, two paired isolates exhibited drug resistance shifting, while four paired isolates revealed inconsistent drug resistance among the re-infection group including two multidrug-resistant tuberculosis (MDR-TB) at the second episode.

Conclusion

Relapse and re-infection contributed equally to the current situation of recurrence TB in Jiangsu, China. Besides, more efficient treatment assessment, specific and vigorous interventions are urgently needed for MDR-TB patients, considering obvious performance among re-infection cases.