Predictors of tuberculosis treatment outcomes among a retrospective cohort in rural, Central India

Abstract

IntroductionProgrammatic design affects access to healthcare and can influence tuberculosis treatment outcomes. Potential predictors of tuberculosis treatment outcomes in one rural Indian setting were examined to improve outcomes with a focus on access to care.MethodsRoutinely collected tuberculosis treatment data from Jan Swasthya Sahyog, a community based healthcare system in rural Chhattisgarh, India were examined from 2003–2015. Predictors were analyzed for associations with death, loss to follow-up or failure in multivariable logistic regression models. The effect of distance from treatment on outcomes was graphed and Pearson's correlation coefficients (r2) calculated. Descriptive time to event analyses were performed for all deaths and loss to follow-up from January 2010 to September 2015.Results4979 patients with active TB were treated during the study period. Patients were mostly male, malnourished, diagnosed with pulmonary disease and many travelled lengthy distances. Positive treatment outcomes improved from 55% to 80% from 2003 to 2015 for all patients though positive treatment outcomes have been above 80% in the primary care setting since 2012. The annual case fatality rate was 4.4% with small yearly variation.Gender and site of treatment (primary versus secondary care facility) and also season of treatment initiation and travel time to care best predicted outcomes in both the complete model and model which included only patients with initial BMI data. No differences were found between primary and secondary care patients for initial BMI, percentage of sputum positivity among those with pulmonary disease and grade of sputum positivity among the sputum positive. Those who traveled the furthest to access care achieved the worst outcomes during the summer and, to a lesser degree, the monsoon. Distance from care was associated with treatment outcomes in a dose-response manner out to substantial distances. From 2010 to 2015, most patients who died or were lost to follow-up did so in the first week of treatment.ConclusionsThe provision of care through local facilities improves the treatment of tuberculosis in rural India. Interventions addressing death or loss to follow-up should focus on the newly diagnosed. Rural Indian physicians should be aware of how access issues affect TB treatment outcomes.

Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study

“…In Karamoja, HIV prevalence is lower than the national average [ 64 ] and as such, HIV is not a major determinant of TB and outcomes: only 4.5% of the study participants were HIV positive. In contrast to other studies [ 17 , 20 ] that had a higher HIV co-infection rate, HIV did not increase the risk of having an unsuccessful TB treatment outcome in this study.…”

Asociación del estado nutricional y factores clínicos con muerte relacionada con tuberculosis en Colombia

“…3,20 . En este mismo sentido, otros autores reportan asociación entre bajo peso y muerte por todas las causas en pacientes con TBC 4,16,[26][27][28] . La alta mortalidad en este grupo de pacientes puede ser debida a la disminución de la inmunidad, ya que el bajo peso puede suprimir la estimulación linfocítica y reducir la secreción de citoquinas pro-inflamatorias 7,29,30 .…”

“…En otras palabras, esto lleva a producir un círculo vicioso sinérgico del estado nutricional adverso. En este mismo sentido existen reportes en los que se relaciona un mayor riesgo de muerte entre los pacientes con TBC y bajo peso 3,4 , por lo que debe considerarse un manejo nutricional del paciente complementario al tratamiento farmacológico contra la TBC [5][6][7] .…”

Clinical, health systems and neighbourhood determinants of tuberculosis case fatality in urban Blantyre, Malawi: a multilevel epidemiological analysis of enhanced surveillance data

“…Our analysis found that models using either distance measurement reached very similar conclusions, and therefore we recommend that in low-resource settings, the simpler measurement (Cartesian distance) should likely be more appropriate for routine programme use. For TB patients that were treated at the city's tertiary hospital (QECH), greater household to clinic distance might be a proxy for lack of access to quality health care service [8,19]. Individuals who live in the peri-urban areas far from the centre of Blantyre have limited resources for transport, and may struggle to access timely tertiary-level health care compared to those living nearer to the centre of the city [20].…”