Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis

Abstract

This review aimed to summarize and estimate the TB treatment success rate and factors associated with unsuccessful TB treatment outcomes in Africa. Potentially eligible primary studies were retrieved from PubMed and Google Scholar. The risk of bias and quality of studies was assessed using The Joanna Briggs Institute’s (JBI) appraisal criteria, while heterogeneity across studies was assessed using Cochran’s Q test and I2 statistic. Publication bias was checked using the funnel plot and egger’s test. The protocol was registered in PROSPERO, numbered CRD42019136986. A total of 26 eligible studies were considered. The overall pooled estimate of TB treatment success rate was found to be 79.0% (95% CI: 76–82%), ranging from 53% (95% CI: 47–58%) in Nigeria to 92% (95% CI: 90–93%) in Ethiopia. The majority of unsuccessful outcomes were attributed to 48% (95% CI: 40–57%) death and 47% (95% CI: 39–55%) of defaulter rate. HIV co-infection and retreatment were significantly associated with an increased risk of unsuccessful treatment outcomes compared to HIV negative and newly diagnosed TB patients with RR of 1.53 (95% CI: 1.36–1.71) and 1.48 (95% CI: 1.14–1.94) respectively. TB treatment success rate was 79% below the WHO defined threshold of 85% with significant variation across countries. Countries need to explore contextual underlining factors and more effort is required in providing TB preventive treatment, improve case screening and linkage for TB treatment among HIV high-risk groups and use confirmatory TB diagnostic modality. Countries in Africa need to strengthen counseling and follow-up, socio-economic support for patients at high risk of loss to follow-up and poor treatment success is also crucial for successful TB control programs.

Assessment of Factors Associated with Unfavorable Outcomes among Drug-Resistant TB Patients: A 6-Year Retrospective Study from Pakistan

“…Perhaps it indicates a need for better access to more effective, less toxic, and easier to implement drug regimens, along with proper engagement of patients in the treatment plan. The current study LTFU rate may be associated with comorbidities, resistance to SLD, previous history of pulmonary TB treatment, gender, and deaths that were not reported to the TB center and access to the PMDT site [34,35].…”

Prevalence of anaemia and associated factors among people with pulmonary tuberculosis in Uganda

“…Low BMI, elevated temperature and night sweats are part of a well-validated TB severity score (the Bandim TBscore) [ 28 ]. Moreover, HIV co-infection with severe immune suppression and high baseline mycobacterial loads are established risk factors for mortality in drug-susceptible and drug-resistant TB [ 29 , 30 ]. Subsequent studies should evaluate the utility of integrating haemoglobin levels in the existent TB severity scores since clinical evaluation of anaemia (pallor) does not correlate well with haemoglobin measurements [ 31 , 32 ].…”

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

“…Cured, treatment completed, treatment failed, died, and defaulted were five exclusive groups of TB treatment results used as a benchmark for global TB data collection and treatment success assessment [12]. The number of TB patients who are cured or completed treatment are considered to have a good treatment outcome, while those who missed treatment, defaulted, or died are considered to have a poor treatment outcome [19,20]. Monitoring TB care outcomes is important for evaluating the efficacy and improvement of TB treatments, as well as identifying possible barriers to TB control [21,22].…”