Background: Following initiation of MDR-TB treatment, patients have a choice to receive follow up DOT supervision at either the central initiating facility or at a peripheral facility. Objectives: We describe the adherence patterns of MDR-TB patients undergoing DOT supervision at the two health facility categories during intensive phase of treatment. Methods: We used a retrospective cohort of patients initiated on MDR TB treatment at Mulago National Referral Hospital between 2014 and 2016. We extracted data from the National Tuberculosis and Leprosy Program records and analysed these using STATA V14. Results: Majority (84.01%) of the patients received their DOT supervision from the peripheral facilities. Males made up 62.1% of patients, and 91.2% had had their household contacts screened for MDR-TB. 26.5% of the patients on peripheral DOT supervision had good adherence to treatment protocol compared to 0% among patients on central initiating health fa- cility DOT supervision. Among the patients with good adherence, 24.1% had contacts screened for MDR-TB as compared to 3.6% with poor adherence. Conclusion: More patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settings. Keywords: MDR-TB; adherence; central initiating; peripheral health facility; DOTS; SORT IT.

BackgroundTo date, limited number of studies have explored the effect of gender in treatment outcomes in Uganda. No data on disaggregated treatment outcomes and influential factors by gender has been comprehensive compiled by the existing studies.Objective To determine the gender differences in TB patients treatment outcomes between 2014 and 2016 in Kampala in order to inform national policy and provide targeted interventions.Methods A retrospective cohort study using routine data of all eligible individuals who were initiated on first-line TB therapy between 2014 and 2016. De-identified data was obtained from all the Kampala divisions electronic TB registers, cleaned and analysed using STATA version 13.Results Of the 18,855 patients started on treatment during the study period, only 17,461 were included in the final analysis. Males were more likely to be 35 years or older, received DOT at facility yet females were more likely to be new patients. In addition, males were more likely to be pulmonary bacteriologically confirmed than females (OR 1.08 95% CI 1.00 - 1.17). Successful treatment completion and ART uptake were similar by gender. Of all outcomes, 83% were treatment successfully, 11% died, 1% treatment failed treatment and 5% got lost to follow-up. Compared to females, males were more likely to be lost from TB care and die compared to females.Conclusion Among TB patients in Kampala from 2014 to 2016, we found evidence that successful treatment completion is not influenced by gender. However other factors that may be associated with successful TB treatment completion include age, disease classification, HIV status and type of patient.

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.