scholarly journals Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study

2020 ◽  
Author(s):  
Jonathan Izudi ◽  
Imelda K. Tamwesigire ◽  
Francis Bajunirwe
Keyword(s):  
Hiv Infection ◽  
Successful Treatment ◽  
Rural Areas ◽  
Retrospective Cohort ◽  
Treatment Success ◽  
Directly Observed Therapy ◽  
Adjusted Risk ◽  
Risk Of Mortality ◽  
Level Of Significance ◽  
Eastern Uganda

Abstract Background Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda. Methods We constructed a retrospective cohort of patients with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we used the modified Poisson regression analysis to determine factors independently associated with treatment success and mortality. Results We retrieved 1,123 patient records. Of these, 477(42.5%) had a cure, 323 (28.0%) had treatment completion, 17(1.5%) had failed treatment, 81(7.2%) had died, 89(7.9%) were lost to follow-up, and 136(12.1%) had missing treatment outcome. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had an outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82-0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81-0.97), or male (aRR, 0.92; 95% CI, 0.87-0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95-6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74-4.92), year of enrollment into treatment from 2015 (aRR, 0.80; 95% CI, 0.66-0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13-0.50). Conclusions Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality is high. HIV infection and older age reduce the chance of successful treatment of tuberculosis, and increase risk of mortality. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success and reduce risk of mortality.

scholarly journals Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study

2020 ◽  
Author(s):  
Jonathan Izudi ◽  
Imelda K. Tamwesigire ◽  
Francis Bajunirwe
Keyword(s):  
Hiv Infection ◽  
Successful Treatment ◽  
Rural Areas ◽  
Retrospective Cohort ◽  
Treatment Success ◽  
Directly Observed Therapy ◽  
Adjusted Risk ◽  
Risk Of Mortality ◽  
Level Of Significance ◽  
Eastern Uganda

Abstract Background Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda.Methods We constructed a retrospective cohort of patients with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we used the modified Poisson regression analysis to determine factors independently associated with treatment success and mortality.Results We retrieved 1,123 patient records. Of these, 477(42.5%) had a cure, 323 (28.0%) had treatment completion, 17(1.5%) had failed treatment, 81(7.2%) had died, 89(7.9%) were lost to follow-up, and 136(12.1%) had missing treatment outcome. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had an outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82-0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81-0.97), or male (aRR, 0.92; 95% CI, 0.87-0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95-6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74-4.92), year of enrollment into treatment from 2015 (aRR, 0.80; 95% CI, 0.66-0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13-0.50).Conclusions Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality is high. HIV infection and older age reduce the chance of successful treatment of tuberculosis, and increase risk of mortality. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success and reduce risk of mortality.

scholarly journals Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study

2020 ◽  
Author(s):  
Jonathan Izudi ◽  
Imelda K. Tamwesigire ◽  
Francis Bajunirwe
Keyword(s):  
Mortality Rate ◽  
Hiv Infection ◽  
Success Rate ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Retrospective Cohort ◽  
Treatment Success ◽  
Treatment Success Rate ◽  
Reduce Mortality Rate ◽  
Eastern Uganda

Abstract Background: Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high dual tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda. Methods: We constructed a retrospective cohort of persons with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we ran a modified Poisson regression analysis to determine factors independently associated with treatment success and mortality rates. Results: We retrieved 1,123 records for persons with BC-PTB and the treatment outcomes were distributed as follows: 477(42.5%) cured, 323 (28.0%) treatment completed, 17(1.5%) treatment failed, 81(7.2%) died, 89(7.9%) lost to follow-up, and 136(12.1%) not evaluated. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had treatment outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82-0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81-0.97), or male sex (aRR, 0.92; 95% CI, 0.87-0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95-6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74-4.92), year of enrollment into treatment after 2015 (aRR, 0.80; 95% CI, 0.66-0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13-0.50). Conclusions: Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality rate is high. HIV infection and older age reduce chances of treatment success, and increase mortality rate. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success rate and reduce mortality rate.

scholarly journals Treatment Outcomes and Associated Factors in Tuberculosis Patients at Atwima Nwabiagya District, Ashanti Region, Ghana: A Ten-Year Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Sadick Ahmed Agyare ◽  
Francis Adjei Osei ◽  
Samuel Frimpong Odoom ◽  
Nicholas Karikari Mensah ◽  
Ernest Amanor ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Success Rate ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Treatment Success ◽  
Treatment Success Rate ◽  
Directly Observed Therapy ◽  
Active Monitoring ◽  
Successful Treatment Outcome ◽  
Unsuccessful Treatment

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.

scholarly journals 1342. Impact of HIV Infection on Treatment Outcome of New Tuberculosis Patients Attending Tuberculosis and Antiretroviral Treatment Services in the Community-Based Hospital, Thailand: A Retrospective Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S485-S486
Author(s):  
Subencha Pinsai
Keyword(s):  
Cohort Study ◽  
Treatment Outcome ◽  
Hiv Infection ◽  
Success Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Treatment Success ◽  
Treatment Success Rate ◽  
Factors Associated ◽  
The Impact

Abstract Background Tuberculosis (TB) and HIV are one of the significant public health problems in Thailand, and an estimated 15,000 individuals have a dual infection. Both HIV and TB each disease speeds up the progression of each other. TB is the leading cause of death in HIV-infected individuals, and HIV coinfected TB patients have disease-specific, and treatment affected their treatment outcomes. There is insufficient evidence on issues of TB and HIV co-infection patients received treatment. This study aimed to assess the impact of HIV status on treatment outcome of TB patients. Methods We conducted a retrospective cohort study among TB patients who registered to service at Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand from October 1, 2017 to October 31, 2018. All patients’ demographic data, diagnosis, and treatment were retrieved. Clinical characteristics, treatment outcome, and factors associated with treatment outcome were analyzed. Results There were 49 (10.65%) HIV among 460 TB patients with a median (IQR) age of 44 (32–61) years old and 65.2% were males. Disseminated TB and extrapulmonary TB were higher in HIV coinfected group (P < 0.001). All pulmonary TB patients’ lower lobe involvement was higher in HIV coinfected group (62.50 vs. 36.00, P = 0.001). In HIV coinfected group median CD4 was 134 cell/mm3 (IQR 19–294), 66.67% were diagnosed HIV infection after TB diagnosis, the median time from TB diagnosed to antiretroviral was 29 days (IQR 21–48). The overall treatment success rate was 93.04%; the treatment success rate was similar in HIV coinfected TB patients (89.80%) and non- HIV-infected patients (93.43%) (P = 0.66).Adverse drug reactions were higher in HIV coinfected group (44.89% vs 12.41%) (P < 0.001). By multiple stepwise logistic regression, factors associated with anti-TB drug adverse reactions were having HIV infection (OR 7.99; 95% CI 3.73–17.10, P < 0.001), Age >60 years (OR 2.64; 95% CI 1.43–4.87, P = 0.002) and female sex (OR 1.97; 95% CI 1.11–3.52, P = 0.02). Conclusion There is a high TB treatment success rate among patients who have treated for TB, but adverse drug events in HIV co-infected TB patients is higher than that observed in non-HIV-infected patients. Disclosures All authors: No reported disclosures.

scholarly journals Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural Eastern Uganda

2019 ◽  
Author(s):  
Jonathan Izudi ◽  
Imelda K Tamwesigire ◽  
Francis Bajunirwe
Keyword(s):  
Treatment Success ◽  
Sub Saharan Africa ◽  
Treatment Programs ◽  
Directly Observed Therapy ◽  
Community Based ◽  
Control Programs ◽  
Continuous Quality ◽  
Sub Saharan ◽  
Using Data ◽  
Eastern Uganda

Abstract Background Well performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors that explain the low and high TSR across four districts in rural eastern Uganda.Methods We interviewed District TB and Leprosy Supervisors (DTLS), Laboratory focal persons (LFPs) and TB focal persons (TBFPs) from four districts in Eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes.Results The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and considered TB as a priority disease. The barriers that were common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities, and a poor implementation of community-based directly observed therapy short course.Conclusion This study shows several factors account for the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.

scholarly journals Presentation, Clinical Characteristics, and Treatment Outcomes among Tuberculous Meningitis Patients with and Without HIV Infection at Vajira Hospital, Thailand: A Retrospective Cohort Study

2021 ◽  
Vol 20 ◽  
pp. 232595822110455
Author(s):  
Lakkana Boonyagars ◽  
Chunlanee Sangketchon ◽  
Kittisak Pholtawornkulchai
Keyword(s):  
Cohort Study ◽  
Hiv Infection ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Tuberculous Meningitis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Final Diagnosis ◽  
Hiv Positive ◽  
Adult Age

To compare the characteristics, presentation, investigations, and outcomes in tuberculous meningitis (TBM) patients with and without human immunodeficiency virus (HIV) coinfection. A retrospective cohort study was conducted on adult (age > 18 years) patients whose final diagnosis was TBM and who were treated at Vajira Hospital, Navamindradhiraj University, Thailand, between January 2005 and December 2016. A final total of 174 individuals were included in the study. Of these, 97 (55.75%) were HIV positive. Treatment was successful in 53 (30.5%) individuals. In HIV-infected TBM patients, there were higher proportions of patients who were younger in age (≤40 years), patients with a low body mass index, history of previous tuberculosis infection, or hepatitis C virus coinfection. A successful treatment outcome rate was lower in HIV-infected TBM patients than in HIV-uninfected TBM patients. Since HIV infection decreases the chance of successful treatment outcomes of TBM patients, future studies are needed to determine the clinical indicators for poorer survival outcomes in HIV-positive TBM patients.

scholarly journals Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural Eastern Uganda

2019 ◽  
Author(s):  
Jonathan Izudi ◽  
Imelda K Tamwesigire ◽  
Francis Bajunirwe
Keyword(s):  
Treatment Success ◽  
Sub Saharan Africa ◽  
Treatment Programs ◽  
Directly Observed Therapy ◽  
Control Programs ◽  
Continuous Quality ◽  
Short Course ◽  
Sub Saharan ◽  
Using Data ◽  
Eastern Uganda

Abstract Background. Optimally performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors associated with the low and high TSR across four districts in rural eastern Uganda. Methods. We interviewed District TB and Leprosy Supervisors, Laboratory focal persons, and health facility TB focal persons from four districts in Eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes. Results . The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and prioritization of better management of people with TB. The barriers common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities , and a poor implementation of community-based directly observed therapy short course. Conclusion. This study shows that several factors are associated with the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.

scholarly journals Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural Eastern Uganda

2019 ◽  
Author(s):  
Jonathan Izudi ◽  
Imelda K Tamwesigire ◽  
Francis Bajunirwe
Keyword(s):  
Treatment Success ◽  
Sub Saharan Africa ◽  
Treatment Programs ◽  
Directly Observed Therapy ◽  
Control Programs ◽  
Continuous Quality ◽  
Short Course ◽  
Sub Saharan ◽  
Using Data ◽  
Eastern Uganda

Abstract Background. Optimally performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors associated with the low and high TSR across four districts in rural eastern Uganda. Methods. We interviewed District TB and Leprosy Supervisors, Laboratory focal persons, and health facility TB focal persons from four districts in Eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes. Results . The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and prioritization of better management of people with TB. The barriers common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities , and a poor implementation of community-based directly observed therapy short course. Conclusion. This study shows that several factors are associated with the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.

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