Diagnosis and treatment outcomes of adult tuberculosis in an urban setting with high HIV prevalence in Sierra Leone: A retrospective study

Abstract

To assess the diagnosis, treatment outcomes, and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. Methods: A retrospective study was conducted of adult TB patients aged 15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. Results: Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n = 1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%), and had pulmonary TB (96.3%). Treatment outcomes were as follows: 29.0% cured, 29.0% completed, 0.5% treatment failure, 24.2% lost to follow-up, 12.8% transferred/not evaluated, and 4.5% died. The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older (adjusted odds ratio 3.48, 95% confidence interval 1.15-10.56; p = 0.027) and HIV-positive status (adjusted odds ratio 3.50, 95% confidence interval 1.72-7.12; p = 0.001) were independent predictors of mortality. Conclusions: Suboptimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets.

Impact of COVID-19 on Tuberculosis Case Detection and Treatment Outcomes in Sierra Leone

“…Despite initial concerns that the COVID-19 pandemic would lead to poor TB treatment outcomes, treatment success rates were significantly higher during the intra-COVID-19 period (April to June 2020) compared with the corresponding period in 2019. These figures represent a modest decline from the overall annual TB treatment success rate of 60% that we had previously reported at this facility in 2017 [23] but remain lower than the national treatment success rate of 89% reported in 2019 [10]. Additionally, we recorded significantly lower rates of loss to follow up and TB-related deaths during the COVID-19 pandemic.…”

Multidrug-resistant tuberculosis in Sierra Leone

“…The analysis found that people who underwent treatment for MDR-TB between 2017 and 2019 showed a treatment success rate of 73% (267 of 365 patients). 6 This result represents a marked improvement on the 60% treatment success rate observed by Lakoh and colleagues 7 among patients with drug-sensitive tuberculosis at the largest treatment centre in Sierra Leone in 2017, but lower than the 88% treatment success rate for drug-sensitive tuberculosis reported countrywide in 2020. 1 These findings are encouraging and suggest that the considerable investments made by the government of Sierra Leone and international partners in establishing a dedicated treatment centre for the care of patients with MDR-TB in 2017 are already yielding public health dividends.…”

“…Untreated HIV increased the risk of unsuccessful treatment 10-fold (adjusted odds ratio 10, 95% CI 2·6–40), consistent with multiple studies from Sierra Leone and sub-Saharan Africa. 7 , 8 Traditionally considered a low-HIV-prevalence country (prevalence of 1·7%), 9 there is growing evidence that the HIV epidemic in Sierra Leone has been expanding over the past 10 years, 9 and its impact on the tuberculosis epidemic is evident in the findings of Kamara and colleagues and others. 6 , 7 In 2020, about 97% of all notified tuberculosis cases in Sierra Leone were screened for HIV, higher than the average 85% screening rate reported for the WHO African region, 1 reflecting a move towards greater integration of tuberculosis and HIV services.…”

The burden of serious fungal infections in Sierra Leone: a national estimate

“… 54 Owing to the limited data, we have not been able to estimate the incidence or prevalence of any form of histoplasmosis, including African Histoplasmosis. In some tertiary hospitals in Sierra Leone, where more than 40% of TB cases are smear-negative, 22 most cases of lung histoplasmosis may be misdiagnosed as smear-negative TB. As a result, the delay in providing the appropriate fungal treatment services to this population.…”