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

2020 ◽  
Author(s):  
Victor Hamilton Singano ◽  
Esther Kip ◽  
Wilson Ching’ani ◽  
Lawrence Chiwaula

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.

2020 ◽  
Author(s):  
Victor Hamilton Singano ◽  
Esther Kip ◽  
Wilson Ching’ani ◽  
Lawrence Chiwaula

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.


2020 ◽  
Author(s):  
Victor Hamilton Singano ◽  
Esther Kip ◽  
Wilson Ching’ani ◽  
Lawrence Chiwaula

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.


2019 ◽  
Author(s):  
Victor Hamilton Singano ◽  
Esther Kip ◽  
Wilson Ching’ani ◽  
Lawrence Chiwaula

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 treatment outcomes than the general population. We investigated the TB treatment outcomes and predictors of unsuccessful treatment outcomes among prisoners and non – prisoners.Methods We retrospectively reviewed TB registers of prisoners and non - prisoners 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). Independent factors of unsuccessful TB treatment outcomes were noted in those 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), HIV positive status (aOR = 0.63: 95% C.I: 0.42 – 0.94).Conclusion Good TB treatment outcomes which are comparable to the general population can be achieved among Malawian prisoners despite the challenging prison conditions.


BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e014679 ◽  
Author(s):  
Christine Sekaggya-Wiltshire ◽  
Barbara Castelnuovo ◽  
Amrei von Braun ◽  
Joseph Musaazi ◽  
Daniel Muller ◽  
...  

PurposeTuberculosis (TB) is a leading cause of death among people living with HIV in sub-Saharan Africa. Several factors influence the efficacy of TB treatment by leading to suboptimal drug concentrations and subsequently affecting treatment outcome. The aim of this cohort is to determine the association between anti-TB drug concentrations and TB treatment outcomes.ParticipantsPatients diagnosed with new pulmonary TB at the integrated TB-HIV outpatient clinic in Kampala, Uganda, were enrolled into the study and started on first-line anti-TB treatment.Findings to dateBetween April 2013 and April 2015, the cohort enrolled 268 patients coinfected with TB/HIV ; 57.8% are male with a median age of 34 years (IQR 29–40). The median time between the diagnosis of HIV and the diagnosis of TB is 2 months (IQR 0–22.5). The majority of the patients are antiretroviral therapy naive (75.4%). Our population is severely immunosuppressed with a median CD4 cell count at enrolment of 163 cells/µL (IQR 46–298). Ninety-nine per cent of the patients had a diagnosis of pulmonary TB confirmed by sputum microscopy, Xpert/RIF or culture and 203 (75.7%) have completed TB treatment with 5099 aliquots of blood collected for pharmacokinetic analysis.Future plansThis cohort provides a large database of well-characterised patients coinfected with TB/HIV which will facilitate the description of the association between serum drug concentrations and TB treatment outcomes as well as provide a research platform for future substudies including evaluation of virological outcomes.Trial registration numberNCT01782950; Pre-results.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sakarn Charoensakulchai ◽  
Chaiyapun Lertpheantum ◽  
Chanapon Aksornpusitpong ◽  
Peeranut Trakulsuk ◽  
Boonsub Sakboonyarat ◽  
...  

Abstract Objective Tuberculosis (TB) is a major cause of morbidity and mortality globally. Despite efforts to eliminate TB in Thailand, the incidence rate has declined slowly. This study aimed to identify the incidence and risk factors of unsuccessful pulmonary TB treatment (failed, died and loss-to- follow up) in a community hospital in Chachoengsao Province, Thailand from 1st January 2013 to 31st December 2019. Results A total of 487 patients were eligible for the study. The incidence of unsuccessful treatment was 21.67/100 population person year. Risk factors of unsuccessful pulmonary TB treatment were unemployment (adjusted hazard ratio (AHR) 3.12, 95%CI 1.41–6.86), HIV co-infection (AHR 2.85, 95%CI 1.25–6.46), previous history of TB (AHR 2.00, 95%CI 1.04–3.81), positive sputum AFB at the end of the intensive phase (AHR 5.66, 95%CI 2.33–13.74), and sputum AFB was not performed at the end of the intensive phase (AHR 18.40, 95%CI 9.85–34.35). This study can be utilized to improve prevention and intervention of TB treatment by strengthening public health system on treatment quality especially TB patient monitoring tools or methods easy for accessing to patients in communities.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Sadick Ahmed Agyare ◽  
Francis Adjei Osei ◽  
Samuel Frimpong Odoom ◽  
Nicholas Karikari Mensah ◽  
Ernest Amanor ◽  
...  

Introduction. Tuberculosis poses a great threat to public health around the globe and affects persons mostly in their productive age, notwithstanding; everyone is susceptible to tuberculosis (TB) infection. To assess the effectiveness and performance of the tuberculosis control program activities, the percentage of cases with treatment success outcome is key. To control tuberculosis, interrupting transmission through effective treatment cannot be overemphasized. The study was conducted to determine factors associated with TB treatment outcome, in the Atwima Nwabiagya District from 2007–2017. Method. A Retrospective review of routine/standard TB registers was carried out in five directly observed therapy short-course (DOTS) centres at the Atwima Nwabiagya District from January 2007 to December 2017. Demographic characteristics, clinical characteristics, and treatment outcomes were assessed. Bivariate and multivariate logistic regression was conducted to determine the predictors of successful treatment outcome. Results. Of the 891 TB client’s data that was assessed in the district, the treatment success rate was 68.46%. Patients, aged ≤ 20 years (adjusted odds ratio aOR = 4.74 , 95 % CI = 1.75 − 12.83 ) and 51-60 years ( aOR = 1.94 , 95 % CI = 1.12 − 3.39 ), having a pretreatment weight of 35-45 kg ( aOR = 2.54 , 95 % CI = 1.32 − 4.87 ), 46-55 kg ( aOR = 2.75 , 95 % CI = 1.44 − 5.27 ) and 56-65 kg ( aOR = 3.04 , 95 % CI = 1.50 − 6.14 ) were associated with treatment success. However, retreatment patients ( aOR = 0.31 , 95 % CI = 0.11 − 0.84 ) resulted in unsuccessful treatment outcome. Conclusion. Successful treatment outcome among TB patients was about 20.00% and 30.00% lower compared to the national average treatment success rate and WHO target, respectively. Active monitoring, motivation, and counselling of retreatment patients and patients with advanced age are key to treatment success.


2020 ◽  
Author(s):  
Benjamin Momo Kadia ◽  
Noah Fongwen Takah ◽  
Christian Akem Dimala ◽  
Victoria Simms

Abstract Background: Despite the scale-up of programmes integrating treatment of tuberculosis (TB) and Human Immuno-deficiency Virus (HIV) in sub-Saharan Africa (SSA), TB treatment outcomes in TB/HIV co-infected patients in the region remain sub-optimal.Objective: To summarize the available evidence on the association between integrated TB/HIV treatment and TB treatment outcomes specifically, successful treatment and all-cause mortality in TB/HIV co-infected adults in SSA.Method: A systematic review of studies published between March 2004 and 10 July 2019 was performed. Seven electronic databases including Medline, Embase and Cochrane were searched to identify interventional and observational quantitative studies reporting on integrated TB/HIV treatment in SSA. Two investigators independently screened the search output, reviewed the eligible studies, and rated the quality of eligible studies using quality assessment tools of the National Heart Lung and Blood Institute. Pooled odds ratios (ORs) were derived using random-effects meta-analysis. Heterogeneity across studies was assessed using the I2 statistic. The confidence in the pooled ORs was rated using the GRADE. The final review was reported using the PRISMA.Results: Eleven studies including 4181 participants were retained. The studies were of moderate to good quality, with 10 being quasi-experimental and cohort. Pooling of relevant studies showed that the odds of treatment success with integration was 1.1 times (95% CI: 0.93-1.29; I2=74.5%; p-value for heterogeneity=0.001) the odds of treatment success without integration and the odds of mortality with integration was 1.27 (95% CI 1.02-1.59; I2=87.3%; p-value for heterogeneity<0.0001) times the odds of mortality without integration. On sensitivity analysis, the odds of mortality with integration decreased to 1.06 (95% CI: 0.83-1.34; I2=80.1%; p-value for heterogeneity<0.0001) times the odds of mortality without integration and there was strong evidence of an association between sample size variation and heterogeneity (p=0.01). Good quality studies (4/11) tended to support the effectiveness of integrated treatment in increasing successful outcomes and decreasing mortality. Certainty in the pooled ORs was low.Conclusion: Evidence on the effect of integrated TB/HIV treatment services on treatment success and all-cause mortality in TB/HIV co-infected patients in SSA is inconclusive but the few available good quality studies tend to favour the effectiveness of these services. More robust primary studies are warranted.


2019 ◽  
Author(s):  
Peter Okpeh Amede ◽  
Elizabeth Adedire ◽  
Aishat Usman ◽  
Celestine A. Ameh ◽  
Faruk S. Umar ◽  
...  

Abstract Background: Tuberculosis (TB) is a contagious disease and its transmissibility potential is increased in congregate settings like the prisons. TB incidence rates are five to fifty times higher among prison inmates than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its predictors in Nigerian prisons. We therefore assessed TB treatment outcomes among prison inmates in Bauchi State, Nigeria. Method: We conducted a retrospective data analysis of inmates with TB in the five main prisons in Bauchi State. We extracted sociodemographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a standardized checklist. We estimated the TB treatment success rate (TSR) and explored the relationship between the TSR and sociodemographic and clinical characteristics. Related variables were modelled in multivariate logistic regression to identify predictors of TSR at 5% level of significance. Results: All 216 inmates were male with mean age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 48 (22.2%) were lost to follow-up, 17 (7.9%) were transferred out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Odds of successful treatment outcome were age; 20-29 years (AOR=10.5; 95% CI: 3.2-35.1), 30-39 years (AOR=4.2; 95% CI: 1.3-13.1), pretreatment weight; 50-59 kg (AOR= 9.6; 95% CI: 1.4-65.6), ≥60 kg (AOR= 18.6; 95% CI: 2.5-140.1) and being HIV negative (AOR=3.3; 95% CI:1.4-7.8). Conclusion: The predictors of successful TB treatment outcome were being less than 40 years of age, having a pretreatment body weight of or greater than 50 kg, imprisonment for less than 2 years, and being HIV negative. We recommended that to improve TB TSR among prison inmates; age, duration of imprisonment, weight and TB/HIV coinfection should be the major consideration during drugs adherence, psychological and nutritional counselling and a tracking system be developed by the prisons authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated. Key words: Tuberculosis, Treatment outcomes, Prison inmates, Predictors, Bauchi State, Nigeria


Author(s):  
Tsegay Legesse ◽  
Mohammed Hussein Elduma ◽  
Nagi Masoud Awad ◽  
Mousab Siddig Elhag ◽  
Israa Abushama ◽  
...  

Background: Refugees are vulnerable to tuberculosis (TB) infection. Tracking of program performance is needed to improve TB care and prevention. The objective of this study was to assess the trends of TB treatment outcomes of notified cases in three refugee camps in Sudan from 2014 to 2017. Methods: This study was a historical cohort study. Sex, age, type of TB, TB patient category, and treatment outcome of all TB cases registered in three refugee camps (Al Kashafa, Shagarab, Wadsherify) from January 1, 2014 to December 31, 2017 were collected from the TB register. Multivariable logistic regression was performed to explore factors for unsuccessful TB treatment. Results: A total of 710 TB cases of which 53.4% were men, 22.1% children (<15 years), and 36.2% extrapulmonary TB (EPTB) were registered. Overall, the TB treatment success rate was 75.7% with a declining trend from 86.2% in 2015 to 63.5% in 2017. On average, 11.4% were lost to follow-up (LTFU), 6.6% died, 5.9% were not evaluated, and in 0.3% the treatment failed. Being 15–24 years old and having EPTB were significantly associated with unsuccessful treatment outcome. Conclusion: The treatment success rate in the refugee camp in 2017 (63.5%) was far lower than the national treatment success rate (78%) and the End TB global target (≥90%) that needs to be improved. LTFU, died, and not evaluated outcomes were high which indicated the necessity to improve the TB treatment program.


2020 ◽  
Author(s):  
Peter Okpeh Amede ◽  
Elizabeth Adedire ◽  
Aishat Usman ◽  
Celestine A. Ameh ◽  
Faruk S. Umar ◽  
...  

Abstract Background : Tuberculosis (TB) is a contagious disease and its transmissibility potential is increased in congregate settings like the prisons. TB incidence rates are five to fifty times higher among prison inmates than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its predictors in Nigerian prisons. We therefore assessed TB treatment outcomes among prison inmates in Bauchi State, Nigeria. Method: We conducted a retrospective data analysis of inmates with TB in the five main prisons in Bauchi State. We extracted sociodemographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a standardized checklist. We estimated the TB treatment success rate (TSR) and explored the relationship between the TSR and sociodemographic and clinical characteristics. Related variables were modelled in multiple logistic regression to identify predictors of TSR at 5% level of significance. Results: All 216 inmates were male with mean (SD) age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 48 (22.2%) were lost to follow-up, 17 (7.9%) were transferred out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Predictors of successful treatment outcome were age; 20-29 years (AOR=10.5; 95% CI: 3.2-35.1), 30-39 years (AOR=4.2; 95% CI: 1.3-13.1), pretreatment weight; ≥ 55kg (AOR= 13.3; 95% CI: 6.0-29.6), imprisonment for ≤ 2 years (AOR= 2.6; 95% CI: 1.3-5.4) and being HIV negative (AOR=3.3; 95% CI:1.4-7.8). Conclusion: The predictors of successful TB treatment outcome were being less than 40 years of age, having a pretreatment body weight of or greater than 55 kg, imprisonment for less than 2 years, and being HIV negative. We recommended that to improve TB TSR among prison inmates; age, duration of imprisonment, weight and TB/HIV co-infection should be the major consideration during pretreatment, psychological and nutritional counselling and a tracking system be developed by the prisons authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated.


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