Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study

Abstract

Background Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high dual tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda. Methods We constructed a retrospective cohort of persons with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we ran a modified Poisson regression analysis to determine factors independently associated with treatment success and mortality rates. Results We retrieved 1123 records for persons with BC-PTB and the treatment outcomes were distributed as follows: 477(42.5%) cured, 323 (28.0%) treatment completed, 17(1.5%) treatment failed, 81(7.2%) died, 89(7.9%) lost to follow-up, and 136(12.1%) not evaluated. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had treatment outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82–0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81–0.97), or male sex (aRR, 0.92; 95% CI, 0.87–0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95–6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74–4.92), year of enrollment into treatment after 2015 (aRR, 0.80; 95% CI, 0.66–0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13–0.50). Conclusions Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality rate is high. HIV infection and older age reduce chances of treatment success, and increase mortality rate. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success rate and reduce mortality rate.

Tuberculosis poor treatment outcomes and its determinants in Kilifi County, Kenya: a retrospective cohort study from 2012 to 2019

“…TB and HIV diagnosis have also been associated with stigma, which might further have adverse effects on TB treatment outcomes [50,51]. Like our study, a number of previous studies have found HIV association with poor TB treatment outcomes [52][53][54]. Surveillance systems like the one in place in our setting should play a key role in providing data for action.…”

Tuberculosis Poor Treatment Outcomes and its determinants in Kilifi County, Kenya: A Retrospective Cohort Study

“…TB and HIV diagnosis have also been associated with stigma, which might further have adverse effects on TB treatment outcome [29,30]. Like our study, a number of previous studies have found HIV association with poor TB treatment outcomes [31][32][33].…”

HIV infection modifies the relationship between distance to a health facility and treatment success rate for tuberculosis in rural eastern Uganda

“…Our data show that among HIV-negative people with TB, long distance was associated with a lower risk of mortality, but among those with TB/HIV, there seemed to be a higher risk for mortality for those traveling longer distances although the relationship did not reach statistical significance. The data suggest that longer distances affect people with TB/HIV more than those without HIV, probably due to complex interaction between HIV and TB, with each disease influencing the other's progression, severity, and response to treatment [26] , [27] , notwithstanding travel distance. Besides, people with TB/HIV who have difficult access to health facilities do not comply with TB treatment [28] and this exacerbates their risk of mortality [29] , [30] .…”