Treatment success rates among tuberculosis patients notified from the private sector in West Bengal, India

In India, an estimated 50% of tuberculosis (TB) patients are diagnosed and managed by private providers (PPs). However, there is limited information on treatment outcomes among those treated by PPs largely because of a lack of systems for patient follow-up and documentation of the outcomes. Tuberculosis Health Action Learning Initiative (THALI) project implemented in six districts of West Bengal, supported PPs in managing TB patients and systematically documented the TB treatment outcomes of such patients. This provided us an opportunity to describe the treatment outcomes and assess factors associated with ‘unsuccessful outcomes’ among TB patients notified by PPs from January to April 2018. This was a retrospective cohort study using routinely collected data. During the study reference period, 2347 patients were notified from 389 PPs. The patient’s mean (SD) age was 39.9 (17.2) years and 61% were males. Of the total, about 86% had pulmonary TB, 95% were new cases, and 23% were microbiologically confirmed (either on sputum smear microscopy or Xpert assay). Among 2347 patients, 19% received free drugs from the National Tuberculosis Program (NTP) under the supervision of PPs while the rest purchased anti-TB drugs from the private pharmacies. The ‘successful outcomes’ (cured and treatment completed) were seen in 86.1% (95% confidence interval (CI), 84.6%-87.4%) patients and 8.6% were ‘not evaluated’. The patients who received free NTP drugs (adjusted relative risk-4.0 (95% CI: 3.1-5.0)) had a higher risk of ‘unsuccessful outcomes’ than those who availed of drugs from private pharmacies. The high ‘successful outcomes’ among TB patients treated by PPs are promising. However, higher ‘unsuccessful outcomes’ among patients on free NTP drugs need to be explored, and suitable corrective actions have to be taken.

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Treatment outcomes of patients with MDR-TB in Nepal on a current programmatic standardised regimen: retrospective single-centre study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2020-000606 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000606 ◽

Cited By ~ 1

Author(s):

Samiksha Ghimire ◽

Samriddhi Karki ◽

Bhagwan Maharjan ◽

Jos G W Kosterink ◽

Daan J Touw ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Retrospective Chart Review ◽

Therapeutic Drug ◽

Sputum Smear ◽

Success Rates ◽

Tb Treatment ◽

Treatment Implementation ◽

Good Treatment Outcome ◽

Mdr Tb

ObjectivesThe objectives of this study were to evaluate treatment in patients on current programmatic multidrug-resistant tuberculosis (MDR-TB) regimen and verify eligibility for the 9-month regimen and therapeutic drug monitoring (TDM).MethodsWe performed a retrospective chart review of patients with MDR-TB receiving standardised regimen at the German Nepal TB Project Clinic, Nepal, between 2014 and 2016. Eligibility for the 9-month regimen and indications for TDM were evaluated.ResultsOut of 107 available patients’ medical records, 98 were included. In this centre, the MDR-TB treatment success rates were 69.0% in 2015, 86.6% in 2016 and 86.5% in 2017. The median time to sputum smear conversion was 60 days (60–90 IQR) and culture conversion was 60 days (60–90 IQR). Observed side effects did not impact treatment outcomes. No difference in treatment success rates was observed between patients with predisposing risk factors and those without. Only 49% (36/74) of patients were eligible for the 9-month regimen and 23 patients for TDM according to American Thoracic Society guideline criteria.ConclusionsNepalese patients with MDR-TB on ambulatory care had good treatment outcome after programmatic treatment. Implementation of the new WHO oral MDR-TB treatment regimen may further improve treatment results. The 9-month regimen and TDM should be considered as part of programmatic care.

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Treatment Outcomes of the Standardized Shorter MDR-TB Regimen under Programmatic Setting: A Retrospective Study from a Tertiary Care Centre, India

Current Respiratory Medicine Reviews ◽

10.2174/1573398x17666211210143240 ◽

2021 ◽

Vol 17 ◽

Author(s):

Swathi Karanth M.P ◽

Somashekar M ◽

Anushree Chakraborty ◽

Swapna R ◽

Akshata J.S ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Tertiary Care ◽

Cross Sectional Study ◽

Sputum Smear ◽

Care Hospital ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Mdr Tb ◽

Set Up

Background: The shorter regimen was widely accepted and advocated for MDR-TB treatment compared tothe conventional longer regimen. Evaluating the performance of both regimens in a programmatic setting will help in tailoring the treatment regimen of MDR-TB. Objectives: 1. To estimate the duration of sputum smear conversion in the shorter MDR-TB regimen. 2. To compare the treatment outcomes of the shorter MDR-TB regimen with that of the longer conventional MDR regimen in a programmatic set up in India. 3. To estimate the adverse drug reactions in the shorter MDR-TB regimen. Methods: A retrospective cross-sectional study was conducted on 320 patients enrolled under programmatic management of drug resistant tuberculosis (PMDT) from April 2017 to May 2019 at a nodal DRTB center and a tertiary care hospital in India. Demographic and clinical characteristics of those who received a shorter MDR-TB regimen were recorded. Treatment outcomes of both regimens were recorded. Treatment success is defined as ‘disease cured and treatment completed’, whereas treatment failure was considered when the treatment was either terminated or changed due to lack of bacteriological conversion at the end of an extended intensive phase or culture reversion in the continuation phase. Results: The treatment success observed in the shorter MDR-TB regimen was 61.25%, which was significantly higher than the conventional longer regimen (p=0.0007). Treatment failures were higher with a shorter MDR-TB regimen (p=0.0001). Conclusion: Treatment success with the shorter MDR-TB regimen though higher than the conventional regimen, is still way behind the target treatment success rate. Improving treatment adherence remains pivotal for achieving end TB targets.

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Tuberculosis in native Israeli Arabs and Jews: trends and treatment outcomes, 1999–2011

Epidemiology and Infection ◽

10.1017/s0950268815000382 ◽

2015 ◽

Vol 143 (15) ◽

pp. 3203-3210 ◽

Cited By ~ 1

Author(s):

H. BISHARA ◽

D. GOLDBLATT ◽

E. RORMAN ◽

Z. MOR

Keyword(s):

Treatment Outcomes ◽

Clinical Laboratory ◽

Treatment Success ◽

Developed Countries ◽

National Average ◽

Success Rates ◽

Pulmonary Tb ◽

Tb Treatment ◽

Lower Treatment ◽

Israeli Arabs

SUMMARYThe incidence of tuberculosis (TB) in native ethnic minorities remains high in developed countries. Arabs, the major ethnic minority in Israel, comprise 21% of its population. This retrospective study compared TB incidence, demographic, clinical, laboratory, genotyping characteristics and treatment outcomes in all Israeli-born citizens diagnosed with TB between 1999 and 2011 by ethnicity, i.e. Israeli-born Arabs (IA) and Jews (IJ). A total of 831 Israeli-born TB patients were reported. Of those, there were 530 (64%) IJ and 301 (36%) IA, with an average annual TB rate of 1·1 and 1·6 cases/100 000 population, respectively, lower than the national average (7·0 cases/100 000 population). TB rates in IA and IJ declined and converged to 1 case/100 000 residents. IA TB patients were more likely to be older, have more pulmonary TB and have lower treatment success rates than IJ. Older age and HIV co-infection, but not ethnicity, were predictive of non-success in TB treatment. Ten mixed IA–IJ clades were detected by spoligotyping and three mixed IA–IJ clusters were identified by MIRU-VNTR typing. Only one IA–IJ couple recalled mutual contact. In conclusion, TB rate in IA was higher than in IJ, but declined and converged in both to 1 case/100 000. Treatment success was high in both groups, and was unrelated to ethnicity.

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Epidemiology of tuberculosis and treatment outcomes among children in Pakistan: a 5 year retrospective study

PeerJ ◽

10.7717/peerj.5253 ◽

2018 ◽

Vol 6 ◽

pp. e5253 ◽

Cited By ~ 4

Author(s):

Madeeha Laghari ◽

Syed Azhar Syed Sulaiman ◽

Amer Hayat Khan ◽

Naheed Memon

Keyword(s):

Retrospective Study ◽

Treatment Outcomes ◽

Urban Areas ◽

Demographic Data ◽

Treatment Success ◽

Clinical Manifestations ◽

Sputum Smear ◽

Unsuccessful Treatment ◽

Patients At Risk ◽

Group 2

Background Regardless of the advancement in medical technologies, the diagnosis of tuberculosis (TB) in children has remained a challenge. Childhood TB is rampant and an important cause of morbidity and mortality. The objective of this study was to determine the trend of TB and treatment outcomes in children aged ≤14 years registered for TB treatment under DOTS course in three districts of Sindh, Pakistan. Methods For this retrospective study, records of TB children (≤14 years) registered for the treatment of TB from January 2011 to December 2015 in three districts of Pakistan, were collected. Demographic data, baseline weight, clinical manifestations, radiography, histopathology results and treatment outcomes were collected from TB unit registers. Results A total of 2,167 children were treated for TB during the study period. Of these, 1,199 (55.3%) were females and 1,242 (57.3%) were from urban areas. Over three-quarter of patients (76.9%) had pulmonary TB with 13.3% of sputum smear positive cases. The overall treatment success rate was 92.4%. In multivariate analysis, rural residents (OR: 2.146, p < 0.001), sputum smear positive cases (OR: 3.409, p < 0.001) and re-treated patients (OR: 5.919, p < 0.001), were significantly associated with unsuccessful treatment outcomes. However, age group ≤2 years, male and those who were underweight were found to have the highest risk of pulmonary tuberculosis (OR: 1.953, p < 0.001; OR: 1.262, p = 0.028; OR: 1.342, p = 0.008), respectively. Conclusion Patients at risk of treatment failure must be given particular attention. Moreover, strategies are needed to further improve the diagnosis and treatment of TB among children and improve the recording system.

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Tuberculosis Treatment Outcomes: A Fifteen Year Retrospective Study in Jos North and Mangu, Plateau State, North – Central Nigeria

10.21203/rs.2.11227/v4 ◽

2020 ◽

Author(s):

Comfort Nanbam Sariem ◽

Patricia Odumosu ◽

Maxwell Patrick Dapar ◽

Jonah Musa ◽

Luka Ibrahim ◽

...

Keyword(s):

Treatment Failure ◽

Treatment Outcomes ◽

Descriptive Analysis ◽

Treatment Success ◽

Infectious Agent ◽

Success Rates ◽

North Central ◽

Tuberculosis Patients ◽

Tb Treatment ◽

Plateau State

Abstract Background: Globally, tuberculosis (TB) is the leading cause of death from a single infectious agent. Adherence to TB therapy is an important factor in treatment outcomes, which is a critical indicator for evaluating TB treatment programs. This study assessed TB treatment outcomes using a fifteen-year record of tuberculosis patients who received treatment in Jos North and Mangu Local Government Areas of Plateau State, North-Central Nigeria. Methods: The retrospective facility based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State. Data were collected from 10156 TB patient’s health records between 2001 and 2015. Treatment outcomes were categorized as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). A descriptive analysis was done to assess the factors associated with treatment outcomes. Relevant bivariable and multivariable logistic regression were done. All statistical analyses were performed on Stata version 11, College station, Texas, USA.Results: During the study period, 58.1% (5904/10156) of the TB patients who received treatment were males. The Mean age ±SD was 35.5 ±15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment. The sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes rate from 83.8% in 2001 to 64.4% in 2015 was observed. After adjusting for sex, and TB category, being HIV positive was 2.8 times (95% CI: 1.11-6.83, p=0.028) more likely to be associated with treatment success than having an unknown status. Treatment after loss to follow-up, relapse and treatment failure were less likely associated with treatment success than newly diagnosed TB patients.Conclusion: With the decrease in treatment success rates, underlying reasons for medication non-adherence and treatment failure should be resolved through adherence counseling involving the patient and treatment supporters, with education on voluntary counseling and testing for HIV among TB patients.

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Re-evaluated treatment outcomes of bacteriologically positive TB patients registered at a clinic in Lusaka, Zambia in 2018

Public Health Action ◽

10.5588/pha.20.0059 ◽

2021 ◽

Vol 11 (1) ◽

pp. 22-25

Author(s):

S. Daka ◽

Y. Matsuoka ◽

M. Ota ◽

S. Hirao ◽

A. Phiri

Keyword(s):

Cohort Study ◽

Treatment Outcomes ◽

Retrospective Cohort ◽

Treatment Success ◽

Success Rates ◽

Treatment Facilities ◽

Almost All ◽

Lost To Follow Up ◽

Diagnostic Centre

SETTING: An urban TB diagnostic centre in Lusaka, Zambia.OBJECTIVE: To re-evaluate treatment outcomes of all bacteriologically confirmed TB patients registered in 2018.DESIGN: This was a retrospective cohort study on TB patients. Treatment outcomes of patients who were transferred out were retrieved.RESULTS: A total of 182 patients were registered, 26 of whom had missing documents; these were excluded from the study. Of the remaining 156 patients who were reviewed, 86 (55.1%) were correctly evaluated by the centre, 35 (22.4%) were incorrectly evaluated and 35 (22.4%) were ‘transferred out’ (not evaluated). As a result of this review, the number of evaluated patients increased from 86 (55.1%) to 150 (96.2%). The cure and treatment success rates rose from 43.6% and 44.2%, respectively, to 57.7% and 73.1%, respectively. Of note, 14 of the 35 patients who were initially declared ‘transferred out’ did not actually reach their treatment facilities and ended up being lost to follow-up.CONCLUSION: This study shows that it is possible to evaluate almost all TB patients. Re-evaluation of treatment outcomes of TB patients revealed the problems in the TB services that need to be improved in the future.

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Complete sputum smear monitoring among adults with pulmonary tuberculosis in central Uganda: evidence from a retrospective cohort study

10.21203/rs.3.rs-570869/v1 ◽

2021 ◽

Author(s):

Norbert Adrawa ◽

Stephen Okoboi ◽

Alimah Komuhangi ◽

Jonathan Izudi ◽

Ronald Nsubuga

Keyword(s):

Pulmonary Tuberculosis ◽

Statistical Significance ◽

Sputum Smear ◽

Smear Microscopy ◽

Limited Information ◽

Directly Observed Therapy ◽

Urban Residence ◽

Community Based ◽

Pulmonary Tb ◽

Adjusted Risk

Abstract Background: People with bacteriologically confirmed pulmonary tuberculosis require sputum smear monitoring at 2, 5, and 6 months to establish treatment outcomes. However, there is limited information about sputum smear monitoring in Uganda, similar to other developing countries. We examined factors associated with complete sputum smear monitoring among persons with bacteriologically confirmed pulmonary TB aged ≥15 years in central Uganda.Methods: We retrospectively reviewed and abstracted data for persons with bacteriologically confirmed pulmonary TB initiated on treatment between January 2017 and December 2019 across 11 large TB units in Masaka district in central Uganda. Complete sputum smear monitoring was measured as the receipt of three sputum smear microscopy tests at 2, 5, and 6 months of TB treatment. The data were summarized descriptively and the differences in the outcome with independent variables were examined using tests of statistical significance. The factors independently associated with the outcome were established using the modified Poisson regression analysis with robust standard errors, reported as adjusted risk ratio (aRR) along with the 95% confidence interval (CI). Results: A total of 416 participants were enrolled, with a mean age of 37.3 ±12.9 years. Of the participants, 290 (69.7) were males, 269 (64.7) were rural residents, and 128 (30.8%) had complete sputum smear monitoring. Urban residence (aRR, 1.45; 95% CI, 1.12-1.90), treatment under the community-based directly observed therapy short-course strategy (DOTS) (aRR, 1.91; 95% CI, 1.25–2.92), and TB and human immunodeficiency virus (TB/HIV) comorbidity (aRR 0.45, 95% CI 0.30–0.68) were associated with complete sputum smear monitoring. Conclusions: We observed a low magnitude of complete sputum smear monitoring among persons with bacteriologically confirmed pulmonary TB aged ≥15 years in central Uganda. Urban residence and treatment under community-based DOTS are associated with a higher likelihood of complete sputum smear monitoring while TB/HIV co-infection is associated with a lower likelihood of complete sputum smear monitoring. At rural health facilities, there is a need to develop strategies to enhance the performance of sputum smear monitoring. Additionally, TB/HIV collaboration and the implementation of community-based DOTS should be strengthened to increase the performance of sputum smear monitoring.

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Is International Travel an Emerging Issue on Transmission of Beijing Lineage Mycobacterium tuberculosis?

Journal of Tropical Medicine ◽

10.1155/2020/9357426 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Pavithra S. Madamarandawala ◽

Srinath Satyanarayana ◽

Collins Timire ◽

Aashifa Yaqoob ◽

Dushantha Madegedara ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Sri Lanka ◽

Treatment Success ◽

International Travel ◽

Sputum Smear ◽

Success Rates ◽

Specific Primers ◽

Tourist Destination ◽

Study Population ◽

Polymerase Chain

Mycobacterium tuberculosis belonging to Beijing sublineage (BL) is associated with high tuberculosis (TB) transmission, multidrug resistance, and adverse treatment outcomes. Sri Lanka experiences an increase in the number of travellers/workers to and from high TB-burden countries, and there is risk of getting BL strains imported into the country. In this context, a cohort study was conducted to assess the prevalence of BL strains among pulmonary tuberculosis (PTB) patients in the Kandy district of Sri Lanka (a popular tourist destination) and its association with patients’ sociodemographic and clinical characteristics. The study population included sputum smear-positive PTB patients diagnosed from February 2018–July 2019. Fresh sputum samples were collected for culturing and conducted polymerase chain reaction using BL-specific primers. Among the 101 patients recruited, presence of BL strains could be ascertained in 94 patients of which 24 (26%; 95% CI: 18%–35%) had BL strains. Prevalence of BL strains was higher among those with high sputum smear grades (2+ and 3+) (P<0.05) and those who had travelled abroad (P<0.05). The prevalence was also higher among young people (aged <35 years). Treatment success rates were similar in patients with (83%) and without BL strains (83% vs. 81%; P value = 0.8375). The prevalence of BL strains in Kandy, Sri Lanka, was high compared to previously reported figures in Sri Lanka, and the percentage drives closer to the countries in South East Asia. International travel raises itself as an emerging issue in BL transmission urging the need of policies and practices in immigration/emigration strategies. The study findings have the potential to alter the TB epidemiology in the country and might represent the situation in other underexplored countries as well. Therefore, it is important to monitor the trends and factors related to the prevalence of Beijing strains globally and make decisions as a whole.

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Tuberculosis treatment outcomes among people living with HIV diagnosed using Xpert MTB/RIF versus sputum-smear microscopy in Botswana: a stepped-wedge cluster randomised trial

BMC Infectious Diseases ◽

10.1186/s12879-019-4697-5 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Tefera Agizew ◽

Violet Chihota ◽

Sambayawo Nyirenda ◽

Zegabriel Tedla ◽

Andrew F. Auld ◽

...

Keyword(s):

Treatment Outcomes ◽

Sputum Smear ◽

Smear Microscopy ◽

People Living With Hiv ◽

Sputum Smear Microscopy ◽

Stepped Wedge ◽

Empiric Treatment ◽

Tb Treatment ◽

Living With Hiv

Abstract Background Xpert® MTB/RIF (Xpert) has high sensitivity for diagnosing tuberculosis (TB) compared to sputum-smear microscopy (smear) and can reduce time-to-diagnosis, time-to-treatment and potentially unfavorable patient-level treatment outcome. Methods People living with HIV (PLHIV) initiating antiretroviral therapy at 22 HIV clinics were enrolled and underwent systematic screening for TB (August 2012–November 2014). GeneXpert instruments were deployed following a stepped-wedge design at 13 centers from October 2012–June 2013. Treatment outcomes classified as an unfavorable outcome (died, treatment failure or loss-to-follow-up) or favorable outcome (cured and treatment completed). To determine outcome, smear was performed at month 5 or 6. Empiric treatment was defined as initiating treatment without/before receiving TB-positive results. Adjusting for intra-facility correlation, we compared patient-level treatment outcomes between patients screened using smear (smear arm)- and Xpert-based algorithms (Xpert arm). Results Among 6041 patients enrolled (smear arm, 1816; Xpert arm, 4225), 256 (199 per 2985 and 57 per 1582 person-years of follow-up in Xpert and smear arms, respectively; adjusted incidence rate ratio, 9.07; 95% confidence interval [CI]: 4.70–17.48; p < 0.001) received TB diagnosis and were treated. TB treatment outcomes were available for 203 patients (79.3%; Xpert, 157; smear, 46). Unfavorable outcomes were reported for 21.7% (10/46) in the smear and 13.4% (21/157) in Xpert arm (adjusted hazard ratio, 1.40; 95% CI: 0.75–2.26; p = 0.268). Compared to smear, in Xpert arm median days from sputum collection to TB treatment was 6 days (interquartile range [IQR] 2–17 versus 22 days [IQR] 3–51), p = 0.005; patients with available sputum test result had microbiologically confirmed TB in 59.0% (102/173) versus 41.9% (18/43), adjusted Odds Ratio [aOR], 2.00, 95% CI: 1.01–3.96, p = 0.048). In smear arm empiric treatment was 68.4% (39/57) versus 48.7% (97/199), aOR, 2.28, 95% CI: 1.24–4.20, p = 0.011), compared to Xpert arm. Conclusions TB treatment outcomes were similar between the smear and Xpert arms. However, compared to the smear arm, more patients in the Xpert arm received a TB diagnosis, had a microbiologically confirmed TB, and had a shorter time-to-treatment, and had a lower empiric treatment. Further research is recommended to identify potential gaps in the Botswana health system and similar settings. Trial registration ClinicalTrials.gov Identifier: NCT02538952. Retrospectively registered on 2 September 2015.

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Tuberculosis (TB) in the Refugee Camps in Ethiopia: Trends of Case Notification, Profile, and Treatment Outcomes, 2014 to 2017

10.21203/rs.3.rs-52830/v1 ◽

2020 ◽

Author(s):

Tsegay Legesse ◽

Goitom Admenur ◽

Selemawit Gebregzabher ◽

Eyob Woldegebriel ◽

Bexabeh Fantahun ◽

...

Keyword(s):

Treatment Outcomes ◽

Data Extraction ◽

Treatment Success ◽

Refugee Camps ◽

Success Rates ◽

Factors Associated ◽

Unsuccessful Treatment ◽

Economic Support ◽

Childhood Tb ◽

Case Notification

Abstract Background: Severity of TB increases in refugee populations. Monitoring TB case notification and treatment outcomes are essential to evaluate the effectiveness of TB programs. This study aimed to determine trends in TB case notification and treatment outcomes and explore factors associated with unsuccessful treatment outcome in refugee camps in Ethiopia. Methods: This retrospective cohort study was conducted from October 2018-June 2019. Demographic and clinical data of all TB cases registered from 2014 to 2017 in 25 refugee camps located in seven refugee areas (Shire, Afar, Gambella, Asossa, Mizam, Jijiga, and Dollo Ado) were extracted using pre-tested data extraction format. Multivariate logistic regression was performed to calculate odds ratios and 95% confidence intervals for factors associated with unsuccessful outcomes.Results. A total of 1553 TB cases, mean age 27.7 years, were registered (2014-2017). Of these notified cases 54.7% were men, 27.7% children (< 15 years), 71.2% pulmonary TB (PTB), 27.8% Extra-PTB (EPTB) and 98.3% new and relapse. From 2014 to 2017: there was consistent increase in the number of notified TB cases (138 to 588 cases), in the percentage of EPTB (23.2% to 32.7%), bacteriologically confirmed pulmonary new and relapse (43.8% to 64.8%), and contribution of children to total TB cases (18.8% to 30.1%) and to EPTB (40.6% to 65.1%). Treatment success rates for all TB cases remained lower at 72.7%-79.4% (on average 11.7% were not evaluated, 8.0% lost to follow-up (LTFU), 4.8% died, and 0.5% failed). Unsuccessful treatment was significantly associated with pretreatment weight below 40 Kg, age over 45 years, and being HIV positive.Conclusions: This study has provided valuable evidences that can help to improve the TB programs. There was increased trend in number of notified TB cases, and in proportion of EPTB, childhood TB, and bacteriologically confirmed pulmonary new and relapse cases. Treatment success rate (2014-2017) was far below global target (90%), and “not evaluated” and LTFU treatment outcomes were higher, which need to be improved. Special socio-economic support and monitoring is required for patients with pretreatment weight below 40 Kg, age over 45 years and HIV positives who at risk for unsuccessful treatment.

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