Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study

Abstract Background Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. Methods We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. Results A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18–0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18–18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11–6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. Conclusions This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.

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Catastrophic costs due to tuberculosis worsen treatment outcomes: a prospective cohort study in Indonesia

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/traa038 ◽

2020 ◽

Vol 114 (9) ◽

pp. 666-673

Author(s):

Ahmad Fuady ◽

Tanja A J Houweling ◽

Muchtaruddin Mansyur ◽

Erlina Burhan ◽

Jan Hendrik Richardus

Keyword(s):

Treatment Outcomes ◽

Treatment Adherence ◽

Mixed Models ◽

Multivariable Analysis ◽

Annual Household Income ◽

Rural Districts ◽

Tb Treatment ◽

Unsuccessful Treatment ◽

One Year

Abstract Background While the incidence of catastrophic costs due to tuberculosis (TB) remains high, there is little evidence about their impact on TB treatment outcomes and adherence. We assessed their effect on treatment outcomes and adherence in Indonesia. Methods We interviewed 282 adult TB patients who underwent TB treatment in urban, suburban and rural districts of Indonesia. One year after the interview, we followed up treatment adherence and outcomes. We applied multivariable analysis using generalized linear mixed models. Results Follow-up was complete for 252/282 patients. Eighteen (7%) patients had unsuccessful treatment and 40 (16%) had poor adherence. At a threshold of 30% of annual household income, catastrophic costs negatively impacted treatment outcomes (adjusted odds ratio [aOR] 4.15 [95% confidence interval {CI} 1.15 to 15.01]). At other thresholds, the associations showed a similar pattern but were not statistically significant. The association between catastrophic costs and treatment adherence is complex because of reverse causation. After adjustment, catastrophic costs negatively affected treatment adherence at the 10% and 15% thresholds (aOR 2.11 [95% CI 0.97 to 4.59], p = 0.059 and aOR 2.06 [95% CI 0.95 to 4.46], p = 0.07). There was no evidence of such an effect at other thresholds. Conclusions Catastrophic costs negatively affect TB treatment outcomes and treatment adherence. To eliminate TB, it is essential to mitigate catastrophic costs.

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Analysis of Tuberculosis Cases Notification and Treatment Outcomes Among Refugee Camps In Kenya: Four Year Retrospective Study, 2014-2017

10.21203/rs.3.rs-116530/v1 ◽

2020 ◽

Author(s):

Tsegay Legesse ◽

Stephen Mulesh ◽

Dorothy Anjuri ◽

Miriam Ngure ◽

Salad Chiari ◽

...

Keyword(s):

Retrospective Study ◽

Treatment Outcomes ◽

Treatment Success ◽

Multiple Logistic Regression Analysis ◽

Refugee Camps ◽

Continuous Increase ◽

Tb Treatment ◽

Unsuccessful Treatment ◽

Childhood Tb

Abstract Background: Tuberculosis (TB) is more severe in refugee populations. Analyzing the key indicators of TB program performance is important to improve the effectiveness of TB control in the refugee camps. This study aimed to analyze trends in TB case notification, treatment outcomes and factors associated with unsuccessful TB treatment in Dadaab and Kakuma refugee camps in Kenya. Methods: In this descriptive retrospective study, demographic and clinical data all TB cases registered in the refugee camps from January 2014 to December 2017 were extracted. Multiple logistic regression analysis was used to estimate odds ratios and 95% confidence intervals for variables associated with unsuccessful TB treatment.Results. A total of 2055 TB cases of whom 56.8% men and 57.7% age 15-44 years were registered. Number of notified cases decreased from 532 in 2014 to 473 in 2016 (11.1% decrease) then increased to 554 in 2017(16.9% increase in one year). From 2014 to 2017 there was consistent increase in percentage of EPTB (16.2% to 21.1%), and in contribution of children (<15 years) to total TB cases (20.3% to 25.8%) and to EPTB (36.1% to 44.4%). Proportion of bacteriologically confirmed new and relapse pulmonary cases increased from 49.5% to 60.9%. Treatment success rate remained higher at 92.6% to 94.4%. On average 41.7% were cured, 2.3% lost to follow-up (LTFU) (increasing from 1.3% to 3.2%), 2.2% died (decreasing from 2.4% to 1.6%), 1.6% not evaluated (decreasing from 3.2% to 1.3%), and 0.5% treatment failed. Unsuccessful treatment outcome was significantly associated with pretreatment weight < 40 Kg, being male, smear positive PTB, HIV infection, and age >15 years (increased with age).Conclusions: Number of notified TB cases has decreased from 2014 to 2016, but increased in 2017. There was continuous increase in percentage of EPTB and childhood TB. Proportion of bacteriologically confirmed new and relapse pulmonary cases has increased overtime. Treatment success remained higher above global target (90%) which should be maintained. Special socioeconomic support and follow-up is required for TB patients who are at higher risk of unsuccessful treatment.

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Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010678 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10678

Author(s):

Melese Yeshambaw Teferi ◽

Ziad El-Khatib ◽

Minyahil Tadesse Boltena ◽

Azeb Tarekegn Andualem ◽

Benedict Oppong Asamoah ◽

...

Keyword(s):

High Risk ◽

Success Rate ◽

Treatment Outcomes ◽

Treatment Success ◽

Treatment Success Rate ◽

Diagnostic Modality ◽

Tb Treatment ◽

Unsuccessful Treatment ◽

Increased Risk

This review aimed to summarize and estimate the TB treatment success rate and factors associated with unsuccessful TB treatment outcomes in Africa. Potentially eligible primary studies were retrieved from PubMed and Google Scholar. The risk of bias and quality of studies was assessed using The Joanna Briggs Institute’s (JBI) appraisal criteria, while heterogeneity across studies was assessed using Cochran’s Q test and I2 statistic. Publication bias was checked using the funnel plot and egger’s test. The protocol was registered in PROSPERO, numbered CRD42019136986. A total of 26 eligible studies were considered. The overall pooled estimate of TB treatment success rate was found to be 79.0% (95% CI: 76–82%), ranging from 53% (95% CI: 47–58%) in Nigeria to 92% (95% CI: 90–93%) in Ethiopia. The majority of unsuccessful outcomes were attributed to 48% (95% CI: 40–57%) death and 47% (95% CI: 39–55%) of defaulter rate. HIV co-infection and retreatment were significantly associated with an increased risk of unsuccessful treatment outcomes compared to HIV negative and newly diagnosed TB patients with RR of 1.53 (95% CI: 1.36–1.71) and 1.48 (95% CI: 1.14–1.94) respectively. TB treatment success rate was 79% below the WHO defined threshold of 85% with significant variation across countries. Countries need to explore contextual underlining factors and more effort is required in providing TB preventive treatment, improve case screening and linkage for TB treatment among HIV high-risk groups and use confirmatory TB diagnostic modality. Countries in Africa need to strengthen counseling and follow-up, socio-economic support for patients at high risk of loss to follow-up and poor treatment success is also crucial for successful TB control programs.

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Delay to initiate treatment is associated with unsuccessful treatment outcome among new pulmonary tuberculosis patients in Tigray, Northern Ethiopia: a follow up study

10.21203/rs.3.rs-527930/v1 ◽

2021 ◽

Author(s):

kiros Tedla ◽

Girmay Medhin ◽

Gebretsadik Berhe ◽

Afework Mulugeta ◽

Nega Berhe

Keyword(s):

Treatment Outcome ◽

Pulmonary Tuberculosis ◽

Treatment Outcomes ◽

Treatment Initiation ◽

Statistical Significance ◽

Northern Ethiopia ◽

Follow Up Study ◽

Unsuccessful Treatment ◽

Increased Risk

Abstract Background : Previous studies in Ethiopia indicated that tuberculosis (TB) patient’s elapse long time before treatment initiation. However, there is very limited evidence on the association of delay to initiate treatment with treatment outcome. Objective : To investigate the association of time to treatment initiation delay with treatment outcomes of new adult TB patients in Tigray region of Ethiopia. Methods : We conducted a follow up study from October 2018 to April 2020 by recruiting 875 newly diagnosed Pulmonary Tuberculosis (PTB) patients from 21 randomly selected health facilities. Study participants were selected using simple random sampling technique during treatment initiation from October 1/2018 to October 30/2019. Delay to initiate treatment and treatment outcome were collected using standardized questionnaire and laboratory investigation. Adherence of TB patients to their treatment was collected using a 10 points linear visual analogue scale (VAS) at the end of treatment. The association of delay to initiate treatment with treatment outcome was modeled using log binomial regression model. Statistical significance was reported whenever p-value was less than 0.05. Data was analyzed using SPSS software version 21. Result : The median total delay to treatment initiation was 62 days with inter-quartile range of 16-221 days. A unite increase in a day to initiate treatment results in increment of risk of unsuccessful treatment outcome by 2.3. Other factors associated with unsuccessful treatment outcomes were being less adherent to the treatment, HIV co infection, being smear positive at initiation of treatment and after 2 months of treatment initiation. Conclusion : delay in a day to initiate treatment is associated with increased risk of unsuccessful treatment outcome. Any effort targeted towards reducing the negative effects of PTB should target on strategies that reduces the length of delay to initiate treatment and strengthen community engagement to improve treatment adherence of patients that have started treatment.

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The impact of smoking on tuberculosis treatment outcomes: a meta-analysis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0002 ◽

2020 ◽

Vol 24 (2) ◽

pp. 170-175 ◽

Cited By ~ 3

Author(s):

E. Y. Wang ◽

R. A. Arrazola ◽

B. Mathema ◽

I. B. Ahluwalia ◽

S. R. Mase

Keyword(s):

Cigarette Smoking ◽

Treatment Outcomes ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Loss To Follow Up ◽

Tb Treatment ◽

The Impact ◽

Culture Conversion

BACKGROUND: Cigarette smoking contributes to tuberculosis (TB) epidemiology. However, limited evidence exists on how smoking impacts TB treatment outcomes such as treatment loss to follow-up and culture conversion.METHODS: This meta-analysis assessed current evidence of the impact of active cigarette smoking on TB treatment outcomes. PubMed, Scopus, Embase, and the Cochrane Library were searched for English-language articles published from database inception through 2017. Articles addressing active pulmonary TB and cigarette smoking were identified and data abstracted. Smokers were defined as those who smoked every day or some days at the time of interview/diagnosis. Non-smokers did not smoke at the time of interview/diagnosis. Unfavorable outcomes included any outcome other than cure or completion of TB treatment. Three different data sets were examined: 8 articles addressing unfavorable treatment outcomes, 9 analyzing only treatment loss to follow-up, and 5 addressing delayed smear or culture conversion. Studies that had <20 subjects or that addressed only populations with comorbidities were excluded.RESULTS: We identified 1030 studies; 21 studies fulfilled the inclusion/exclusion criteria. Smokers had greater odds of unfavorable outcomes (pooled odds ratio [pOR] 1.23, 95%CI 1.14–1.33), delayed smear or culture conversion (pOR 1.55, 95%CI 1.04–2.07), and treatment loss to follow-up (pOR 1.35, 95%CI 1.21–1.50).CONCLUSION: Cigarette smoking is associated with negative treatment results and delayed conversion to negative smear or culture, suggesting smoking is an important factor for consideration in TB elimination efforts.

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Multidrug-resistant tuberculosis in the Kharkiv Region, Ukraine

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0508 ◽

2020 ◽

Vol 24 (5) ◽

pp. 485-491

Author(s):

D. Butov ◽

C. Lange ◽

J. Heyckendorf ◽

I. Kalmykova ◽

T. Butova ◽

...

Keyword(s):

Treatment Outcomes ◽

Drug Susceptibility ◽

Multidrug Resistant ◽

Drug Susceptibility Testing ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Poor Treatment ◽

Mdr Tb ◽

Observational Cohort

OBJECTIVE: To document the level of drug resistance in MDR-TB patients and to characterize management capacities for their medical care and MDR-TB treatment outcomes in the Kharkiv region of Ukraine. This area has one of the highest frequencies of MDR-TB worldwide.METHODS: A retrospective observational cohort study was performed on registry data from the regional anti-TB dispensary in Kharkiv. All microbiologically confirmed MDR-TB patients registered in 2014 were included. Diagnostic, treatment and post-treatment follow-up data were analysed.RESULTS: Of 169 patients with MDR-TB, 55.0% had pre-extensively drug-resistant (pre-XDR) or XDR resistant patterns. Rapid molecular diagnosis by GeneXpert and liquid M. tuberculosis cultures were only available for 66.9% and 56.8% of patients, respectively. Phenotypic drug-susceptibility testing (DST) for high priority TB drugs (bedaquiline, linezolid, clofazimine) were not available. DST for later generation fluroquinolones was available only in 53.2% of patients. 50.9% of patients had less than 4 drugs in the treatment regimen proven to be effective by DST. More than 23.1% of patients with MDR-TB failed their treatment and only 45.0% achieved a cure.CONCLUSION: The high prevalence of MDR-TB and poor MDR-TB treatment outcomes in the Kharkiv region, is associated with substantial shortages in rapid molecular and phenotypic DST, a lack of high priority MDR-TB drugs, poor treatment monitoring and follow-up capacities.

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Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study

BMC Medicine ◽

10.1186/s12916-020-01815-3 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Tammy Y. N. Tong ◽

Paul N. Appleby ◽

Miranda E. G. Armstrong ◽

Georgina K. Fensom ◽

Anika Knuppel ◽

...

Keyword(s):

Cox Regression ◽

Diet Group ◽

Economic Factors ◽

Death Certificates ◽

Site Specific ◽

Main Site ◽

Specific Fracture ◽

Fracture Risks ◽

Socio Economic Factors

Abstract Background There is limited prospective evidence on possible differences in fracture risks between vegetarians, vegans, and non-vegetarians. We aimed to study this in a prospective cohort with a large proportion of non-meat eaters. Methods In EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up (≈ 2010). Participants were categorised into four diet groups at both time points (with 29,380 meat eaters, 8037 fish eaters, 15,499 vegetarians, and 1982 vegans at baseline in analyses of total fractures). Outcomes were identified through linkage to hospital records or death certificates until mid-2016. Using multivariable Cox regression, we estimated the risks of total (n = 3941) and site-specific fractures (arm, n = 566; wrist, n = 889; hip, n = 945; leg, n = 366; ankle, n = 520; other main sites, i.e. clavicle, rib, and vertebra, n = 467) by diet group over an average of 17.6 years of follow-up. Results Compared with meat eaters and after adjustment for socio-economic factors, lifestyle confounders, and body mass index (BMI), the risks of hip fracture were higher in fish eaters (hazard ratio 1.26; 95% CI 1.02–1.54), vegetarians (1.25; 1.04–1.50), and vegans (2.31; 1.66–3.22), equivalent to rate differences of 2.9 (0.6–5.7), 2.9 (0.9–5.2), and 14.9 (7.9–24.5) more cases for every 1000 people over 10 years, respectively. The vegans also had higher risks of total (1.43; 1.20–1.70), leg (2.05; 1.23–3.41), and other main site fractures (1.59; 1.02–2.50) than meat eaters. Overall, the significant associations appeared to be stronger without adjustment for BMI and were slightly attenuated but remained significant with additional adjustment for dietary calcium and/or total protein. No significant differences were observed in risks of wrist or ankle fractures by diet group with or without BMI adjustment, nor for arm fractures after BMI adjustment. Conclusions Non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures. This is the first prospective study of diet group with both total and multiple specific fracture sites in vegetarians and vegans, and the findings suggest that bone health in vegans requires further research.

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The effect of concurrent mental illness on tuberculosis treatment outcomes at Butabika National Referral Mental Hospital – Uganda

10.21203/rs.2.10222/v1 ◽

2019 ◽

Author(s):

Derrick Kimuli ◽

Etwom Alfred ◽

Nicholas Sebuliba Kirirabwa ◽

Racheal Tibyonza ◽

Daniel Ayen Okello ◽

...

Keyword(s):

Mental Illness ◽

Treatment Outcomes ◽

Mental Hospital ◽

Quality Care ◽

Psychosocial Assessment ◽

Hiv Positive ◽

Targeted Interventions ◽

Tb Treatment ◽

The Impact

Abstract Background The renaissance of tuberculosis (TB) through certain groups of the population including patients with mental illness has been observed for the last 30 years. However, literature on treatment outcomes of patients with mental illness is still scarce. The following research examines the impact of concurrent mental health illness on TB treatment outcomes in Butabika National Referral Mental Hospital. Methods A retrospective analysis of data for registered TB patients with and without mental-illness for the period July 2013 to December 2015. Data was extracted for age, sex, human immunodeficiency virus (HIV) serostatus and Directly Observed Treatment (DOT) status, TB classification and history of TB treatment. For HIV co-infected patients, data on Co-trimoxazole preventative therapy (CPT) and anti-retroviral therapy (ART) uptake was collected. Treatment outcomes of patients with and without mental illness were analyzed. Results A total of 325 records were analyzed, of which 105 (32%) patients were found to have had mental illness. Of the patients with mental illness, 61 (58%) were HIV positive while of those without mental illness, 134 (61%) were HIV positive. Patients with mental illness were less likely to complete treatment (adj. OR 0.3, 95% CI 0.2 - 0.5, p = 0.000) more likely to die, (adj. OR 2.3, 95% CI 1.2 – 4.3, p = 0.01) and more likely to get lost to follow up during treatment (adj. OR 2.8, 95% CI 1.3 – 6.0, p = 0.005) compared to those without mental illness. Conclusion Mental illness is associated with unfavorable outcomes of TB treatment. We recommend targeted interventions for patient follow up at this hospital and further studies to guide improvement in the quality care in this patient population. We also recommend psychosocial assessment and counselling for all patients on TB treatment as practice to improve treatment outcomes for all TB patients in Kampala.

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Tuberculosis Treatment Outcomes Among Prisoners and General Population in Zomba, Malawi

10.21203/rs.2.16474/v3 ◽

2020 ◽

Author(s):

Victor Hamilton Singano ◽

Esther Kip ◽

Wilson Ching’ani ◽

Lawrence Chiwaula

Keyword(s):

Treatment Outcome ◽

General Population ◽

Treatment Outcomes ◽

Sub Saharan Africa ◽

Pulmonary Tb ◽

Successful Treatment Outcome ◽

Tb Treatment ◽

Monitoring Tools ◽

Unsuccessful Treatment ◽

Sub Saharan

Abstract Background TB remains a major global health problem. it is particularly prevalent in prisons in sub-Saharan Africa. Prisoners have experienced worse TB treatment outcomes than the general population. The researchers investigated the TB treatment outcomes and pre d ictors of unsuccessful treatment outcomes among prisoners and the general population. Methods We retrospectively reviewed TB registers of prisoners and the general population diagnosed with TB from January 2011 to December 2016 at Zomba Maximum Central Prison and Zomba Central Hospital, Malawi. The study used routinely collected data extracted from national, standardized TB treatment monitoring tools. Successful treatment outcome was classified as the total for cured and completed treatment while unsuccessful treatment outcome was classified as the total of deaths and treatment failures. We used descriptive statistics to compare the demographics and TB treatment parameters among prisoners and non – prisoners and computed multivariate analysis to predict the independent factors of unsuccessful treatment outcomes. Results Of 1652 registered cases, 27% were prisoners (all males) and 72% were non-prisoners (58 % males). The median age was 35 years (IQR: 29 - 42); 76 % were Pulmonary TB cases (78 % among prisoners vs 75% among non-prisoners); 83 % were new TB cases (77% among prisoners vs 86% among non-prisoners); and 65 % were HIV positive (50 % among prisoners vs 71% among non – prisoners). Regarding treatment outcome, 1472 (89%) were cured and/or completed treatment (93% among prisoners vs 88 % among non – prisoners), 2 (0.2%) were treatment failures, 122 (8%) died (5 % among prisoners vs 8 % among non – prisoners) and 55 (3%) were not evaluated (1% among prisoners vs 4% among non – prisoners). Unsuccessful TB treatment outcomes were associated with age greater than 35 years (aOR = 0.68: 95% C.I: 0.58 – 0.80), Extra-Pulmonary TB (aOR=1.69: 95% C.I: 1.08 – 2.63) andHIV positive status (aOR = 0.63: 95 % C.I: 0.42 – 0.94). Conclusion Maximum prisons provide a stable population that can be easily monitored during TB treatment. Good TB treatment outcomes comparable to the general population can be achieved among prisoners despite the challenging prison conditions.

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Tuberculosis Treatment Outcomes Among Prisoners and General Population in Zomba, Malawi

10.21203/rs.2.16474/v4 ◽

2020 ◽

Author(s):

Victor Hamilton Singano ◽

Esther Kip ◽

Wilson Ching’ani ◽

Lawrence Chiwaula

Keyword(s):

Treatment Outcome ◽

General Population ◽

Treatment Outcomes ◽

Sub Saharan Africa ◽

Pulmonary Tb ◽

Successful Treatment Outcome ◽

Tb Treatment ◽

Monitoring Tools ◽

Unsuccessful Treatment ◽

Sub Saharan

Abstract Background: TB remains a major global health problem. It is particularly prevalent in prisons in sub-Saharan Africa due to overcrowding, malnutrition, high HIV prevalence and insufficient medical services. Prisoners have experienced worse TB treatment outcomes than the general population. The researchers investigated the TB treatment outcomes and predictors of unsuccessful treatment outcomes among prisoners and the general population in Zomba, Malawi. Methods: We retrospectively reviewed TB registers of prisoners and the general population diagnosed with TB from January 2011 to December 2016 at Zomba Maximum Central Prison and Zomba Central Hospital, Malawi. The study used routinely collected data extracted from national, standardized TB treatment monitoring tools. Successful treatment outcome was classified as the total for cured and completed treatment while unsuccessful treatment outcome was classified as the total of deaths and treatment failures. We used descriptive statistics to compare the demographics and TB treatment parameters among prisoners and non – prisoners and computed multivariate analysis to predict the independent factors of unsuccessful treatment outcomes.Results : Of 1652 registered cases, 27% were prisoners (all males) and 72% were non-prisoners (58 % males). The median age was 35 years (IQR: 29 - 42); 76 % were Pulmonary TB cases (78 % among prisoners vs 75% among general population); 83 % were new TB cases (77% among prisoners vs 86% among general population); and 65 % were HIV positive (50 % among prisoners vs 71% among general population). Regarding treatment outcome, 1472 (89%) were cured and/or completed treatment (93% among prisoners vs 88 % among general population), 2 (0.2%) were treatment failures, 122 (8%) died (5 % among prisoners vs 8 % among general population) and 55 (3%) were not evaluated (1% among prisoners vs 4% among general population). Unsuccessful TB treatment outcomes were associated with age greater than 35 years (aOR = 0.68: 95% C.I: 0.58 – 0.80), Extra-Pulmonary TB (aOR=1.69: 95% C.I: 1.08 – 2.63) andHIV positive status (aOR = 0.63: 95 % C.I: 0.42 – 0.94).Conclusion: Maximum prisons provide a stable population that can be easily monitored throughout the course of TB treatment. Good TB treatment outcomes which are comparable to the general population can be achieved among Malawian prisoners despite the challenging prison conditions.

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