Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria

Abstract

Background The Lagos State Tuberculosis, Buruli Ulcer, and Leprosy Control Program (LSTBLCP) started engaging private hospitals under the Public-Private Mix (PPM) Program in 2008. The study aimed to evaluate the trend and predictors of successful Tuberculosis (TB) treatment outcomes of patients managed across these private health facilities between 2010–2016 in Lagos, Nigeria. Methods Retrospective review of TB treatment register and treatment cards of patients commenced on TB treatment between January 2010 and December 2016 in 36 private health facilities engaged by the LSTBLCP. Between December 2016 and February 2017, data were collected and entered into Microsoft Excel by trained data entry clerks. The analysis was done using SPSS software. Independent predictors of successful treatment outcomes were determined using multivariate analysis at the statistical significance of p<0.05 and 95% confidence interval. Results A total of 1660 records of TB patients were reviewed. 1535 (92.47%) commenced treatment, while 1337 (87.10%) of all records had documented treatment outcomes. Of the 1337 patients with outcomes, 1044 (78.09%) had a successful treatment outcome, and 293 (21.91%) had an unsuccessful outcome. Majority were male, 980 (59.04%), Human Immunodeficiency Virus (HIV) negative status, 1295 (80.24%), diagnosed with smear, 1141 (73.14%), treated in private not-for-profit (PNFP) hospital, 1097 (66.08%), treated for TB between 2014–2016 (18.96%-19.52%). In multivariate analysis, age>20years (aOR = 0.26, p = 0.001), receiving TB treatment in 2013 (aOR = 0.39, p = 0.001), having genexpert for TB diagnosis (aOR = 0.26, p = 0.031) and being HIV positive (aOR = 0.37, p = 0.001) significantly reduced likelihood of successful treatment outcome. The site of TB, being on ART or CPT, were confounding determinants of successful treatment outcomes as they became non-significant at the multivariate analysis level. Conclusion Treatment outcome among Lagos private hospitals was low compared with NTBLCP and World Health Organization (WHO) target. We urge the government and TB stakeholders to strengthen the PPM interventions to improve adherence, particularly among People Living with HIV (PLHIV) and older TB patients. Hence, promotion of early care-seeking, improving diagnostic and case holding efficiencies of health facilities, and TB/HIV collaborative interventions can reduce the risk of an unsuccessful outcome.

Determinants of tuberculosis treatment outcomes in Asia and Africa

“…This systematic review used the procedures specified in the PRISMA guidelines as a guide for reporting systematic reviews and meta-analyses (Page et al, 2021). Inclusion criteria are studies that reported the determinants and outcomes of TB treatment, have access to a full text, are in English, and are published in the last ten years, considering that the increase in TB has occurred in several countries in Asia and Africa since 2013 (WHO, 2020), which is in line with the results of the study that an increase in TB diagnoses in Nigeria has occurred since 2010, and an increase in TB incidence in Ethiopia has occurred since 2012 (Muluye et al, 2018;Oladimeji et al, 2021). Articles will be excluded if the study location is not in the Asian and African continents, the study design is a systematic review, or the study population is MDR TB patients or TB with comorbidities.…”

“…Internal factors consist of 11 determinants from within the TB patient, namely age, gender, education, HIV status, TB location, treatment category, alcohol consumption, drug use, smoking, type of ARB (Acid Resistant Bacteria), and comorbidities (Ahmad et al, 2020;Atif et al, 2014;Babalik et al, 2014;Banerjee et al, 2020;DesJardin et al, 2020;García-Basteiro et al, 2016;Habte et al, 2020;Khazaei et al, 2016;Mohammadzadeh et al, 2016;Mulogo et al, 2017;Muluye et al, 2018;Mundra et al, 2019;Ogbudebe et al, 2018;Oladimeji et al, 2021;Sadana et al, 2020;Sahyog et al, 2018;Son et al, 2021;Tesema et al, 2020;Tetteh et al, 2018;Umeokonkwo et al, 2020;Wen et al, 2018). 13 articles described age as an internal factor for TB treatment outcomes (Ahmad et al, 2020;Atif et al, 2014;Babalik et al, 2014;Habte et al, 2020;Mundra et al, 2019;Ogbudebe et al, 2018;Oladimeji et al, 2021;Sadana et al, 2020;Son et al, 2021;Tesema et al, 2020;Tetteh et al, 2018;Umeokonkwo et al, 2020;Wen et al, 2018). The likelihood of a successful treatment outcome was higher among patients aged 15-24 years, compared to patients younger than 14 years (Tesema et al, 2020), and over 61 years (Ahmad et al, 2020;Habte et al, 2020).…”

Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers

“…Outside of Nigeria, most studies examining private sector TB service delivery in LMICs including Ethiopia, India, Kenya, the Philippines, and Thailand, have identified important shortcomings in effectiveness of tuberculosis cases management by private clinicians and pharmacists [9][10][11][12][13][14][15][16][17]. Within Nigeria, several studies have examined treatment success rates (TSR) in clinical facilities participating in small-scale PPM pilots in Anambra, Imo, Kaduna, Lagos, Ogun, and Plateau states [7,[18][19][20][21][22][23]. Although these studies found that observed TSR for private sector patients was lower than Nigeria's national treatment success target of 90 percent, these rates were often comparable to TSR reported for public sector patients in those states [7,[18][19][20][21][22][23], which supports continued scale up of PPM in Nigeria to increase access to care.…”

“…Within Nigeria, several studies have examined treatment success rates (TSR) in clinical facilities participating in small-scale PPM pilots in Anambra, Imo, Kaduna, Lagos, Ogun, and Plateau states [7,[18][19][20][21][22][23]. Although these studies found that observed TSR for private sector patients was lower than Nigeria's national treatment success target of 90 percent, these rates were often comparable to TSR reported for public sector patients in those states [7,[18][19][20][21][22][23], which supports continued scale up of PPM in Nigeria to increase access to care.…”

“…The SHOPS Plus network model's ability to provide quality services is currently untested, and it is not well understood whether enhancing multiple cadres of private providers' TB knowledge and management capacity contributes to overall improvements in TB quality of care in Nigeria. Existing studies of PPM care quality [7,[18][19][20][21][22][23] in Nigeria have focused primarily on treatment outcomes, rather than screening and treatment initiation, and have also exclusively focused on clinical providers. To fill this gap, we used a standardized patient (SP) (also known as the "simulated patient" or "mystery client") survey method to rigorously examine the levels of quality of presumptive and newly diagnosed TB patient management in the private sector of two Nigerian states, the variation across facility cadres, and to assess differences between providers in a private sector program compared to public sector providers.…”