Predictors of mortality and treatment success of multi-drug resistant and Rifampicin resistant tuberculosis in Zimbabwe: a retrospective cohort analysis of patients initiated on treatment during 2010 to 2015

Matambo, Ronnie; Nyandoro, George; Sandy, Charles; Nkomo, Tendai; Mutero-Munyati, Shungu; Mharakurwa, Sungano; Chikaka, Elliot; Ngwenya, Mkhokheli; Ndongwe, Gilchriste; Pepukai, Mildred

doi:10.11604/pamj.2021.39.128.27726

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…Additionally, declined living standard, mental stress associated with nancial hardship might worsen treatment adherence. Missing doses of drugs, inappropriate use of drugs and side effects in turn could end up with more severe disease, ampli ed drug-resistance and treatment failure (19,22) (22) (23) (24). Prolonged, irregular treatment could potentially cause further transmission of drug-resistant strains in health facilities (25).…”

Section: Introductionmentioning

confidence: 99%

Impact of financial support on treatment outcomes of multidrug-resistant tuberculosis: a population-based, retrospective cohort study in China

Chen

Zhang

et al. 2022

Preprint

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Background To date, the treatment success rate of Multidrug-resistant tuberculosis (MDR-TB) is low. The prolonged treatment course and expensive second-line anti-tuberculosis drugs (SLDs) for treating MDR-TB could lead to heavy financial expenditure. This economic barrier might result in poor adherence, lost to follow-up and treatment failure. Therefore, provision of financial support might improve treatment outcomes of MDR-TB. This study investigated the association between a subsidy policy and treatment outcomes of MDR-TB patients. Methods In this population-based, retrospective study, demographic, clinical characteristics, and the drug susceptibility profiles of all registered MDR-TB patients between 2011 and 2019 in Shanghai, China were collected. In total, 865 of 1016 patients were eligible for analysis, among which 70.6% (611/865) had treatment success. Information on the subsidies for MDR-TB treatment, which was in addition to the basic health insurance, were routinely recorded by the end of December 2021. Multivariate logistic regression adjusted for potential confounders was performed to evaluate the association between the situation of subsidies and treatment outcomes by estimating odds ratios (ORs) and 95% confidence intervals (CIs). The effect of greater/less subsidies on outcomes was further assessed using the median amount of financial support as cut-off points. Results During the study period, 74.1% (641/856) patients received subsidies for MDR-TB treatment. The median subsidies received across the treatment course was 15026 (Interquartile range, IQR, 7107–36001) Chinese Yuan (CNY), of which the reimbursement for SLDs were the major components. Those who had treatment success received significantly more subsidies (median, 17836 CNY) compared with patients with adverse outcomes (9794 CNY, P < 0.001). Benefiting from the subsidy policy was positively associated with treatment success, with an adjusted odds ratio (OR) equal to 2.95 (95% confidence interval [CI], 2.03–4.28). Among 641 patients who received subsidies, the OR comparing those with greater and less reimbursement was 1.74 (95% CI, 1.16–2.61). Additional adjustment for baseline drug-resistance did not alter these results. Conclusions Financial support was positively associated with better treatment outcomes among MDR-TB patients. Results in this study call for further financial assistance to facilitate appropriate medical care and to improve treatment outcomes of MDR-TB.

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Section: Introductionmentioning

confidence: 99%

Impact of financial support on treatment outcomes of multidrug-resistant tuberculosis: a population-based, retrospective cohort study in China

Chen

Zhang

et al. 2022

Preprint

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Impact of financial support on treatment outcomes of multidrug-resistant tuberculosis: A population-based, retrospective cohort study in Shanghai, China

Chen,

Shen,

Zhang

et al. 2024

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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Predictors of mortality among multidrug-resistant tuberculosis patients after decentralization of services in Tanzania from 2017 to 2019: retrospective cohort study

Mrema,

Hussein,

Magoge

et al. 2024

Bull Natl Res Cent

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Background Multidrug-resistant tuberculosis (MDR-TB) presents persistent global health challenges, characterized by low treatment success rates among patients enrolled for treatment. The World Health Organization recommends decentralization to improve outcomes. This study aims to assess predictors of mortality among MDR-TB patients after decentralization of services in Tanzania. This was a retrospective cohort study involving all MDR-TB patients enrolled in treatment in all 31 regions in Tanzania from 2017 to 2019. The overall mortality rate among MDR-TB patients was calculated using the incidence rate. Additionally, independent factors of MDR-TB mortality were determined using multivariable cox proportional hazards models. Results The study followed 985 patients for a total of 12,929 months. During this time, it found that approximately 12 out of every 1000 patients died each month. Specifically, the death rates were about 18 out of 1000 patients at 6 months, 8 out of 1000 at 12 months, and 7 out of 1000 at 24 months. Patients who had both MDR-TB and HIV, as well as those who were malnourished, had a lower chance of surviving at 6, 12, and 24 months. Malnourished patients had almost three times the risk of dying [adjusted hazard ratio (aHR) 2.96, with a 95% confidence interval (CI) of 2.10–4.19], while those with HIV had nearly double the risk [aHR 1.91, with a 95% CI of 1.37–2.65]. Conclusion In summary, our study on MDR-TB patient outcomes in Tanzania between 2017 and 2019 reveals a pattern of high mortality rates within the first 6 months of treatment. Furthermore, malnutrition and HIV co-infection were found to be significant predictors of mortality. To decrease mortality, it is crucial to closely monitor patients during the initial 6 months of treatment, especially those who are malnourished or co-infected with HIV, and ensure they receive appropriate and timely care. Additionally, further investigation is needed to find out what may be contributing to possible rise in mortality rate.

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Predictors of mortality and treatment success of multi-drug resistant and Rifampicin resistant tuberculosis in Zimbabwe: a retrospective cohort analysis of patients initiated on treatment during 2010 to 2015

Cited by 3 publications

References 14 publications

Impact of financial support on treatment outcomes of multidrug-resistant tuberculosis: a population-based, retrospective cohort study in China

Impact of financial support on treatment outcomes of multidrug-resistant tuberculosis: a population-based, retrospective cohort study in China

Impact of financial support on treatment outcomes of multidrug-resistant tuberculosis: A population-based, retrospective cohort study in Shanghai, China

Predictors of mortality among multidrug-resistant tuberculosis patients after decentralization of services in Tanzania from 2017 to 2019: retrospective cohort study

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