Tuberculosis treatment outcome and predictors in northern Ethiopian prisons: a five-year retrospective analysis

Abstract

BackgroundThe prison situations are notorious for causing interruptions of tuberculosis (TB) treatment and occurrence of unfavorable outcomes. In Ethiopian prisons, though TB treatment programs exist, treatment outcome results and factors contributing to unsuccessful outcome are not well documented. In this study, we assessed the treatment outcome of TB cases and identified risk factors for unsuccessful outcome in northern Ethiopian prisons.MethodsA retrospective record review was conducted for all prisoners diagnosed with TB between September 2011 and August 2015. Outcome variables were defined following WHO guidelines.ResultsOut of the 496 patients, 11.5% were cured, 68% completed treatment, 2.5% were lost to follow-up, 1.6% were with a treatment failure, 1.4% died, and 15% were transferred out. All transferred out or released prisoners were not appropriately linked to health facilities and might be lost to treatment follow-up. The overall treatment success rate (TSR) of the 5 years was 94% among the patients who were not transferred out. The odds of unsuccessful outcome were 4.68 times greater among re-treatment cases compared to the newly treated cases. The year of treatment was also associated with variations in TSR; those treated during the earlier year were more likely to have unsuccessful outcome. Sputum non-conversion at the second-month check-up was strongly associated with unsuccessful outcome among the smear-positive cases.ConclusionsThe mean TSR of the prisoners in the study prisons was quite satisfactory when gauged against the target level set by the End TB Strategy. However, the lack of appropriate linkage and tracking systems for those prisoners transferred or released before their treatment completion would have a negative implication for the national TB control program as such patients might interrupt their treatment and develop drug-resistant TB. Being in a re-treatment regimen and sputum non-conversion at the second-month check-up were significantly associated with unsuccessful treatment outcome among the all forms of and smear-positive TB cases, respectively.

Tuberculosis Treatment Outcomes Among Prisoners and General Population in Zomba, Malawi

“…This is also higher than the 73 % TSR [16] from 27 prisons in Malawi in 2007, 66% TSR reported in Zambian prison [17] in 2010 -2011 and 48 % TSR in Ugandan prisons [6] from 2011 to 2012. However, the TSR is comparable to recent studies done in prisons in section Ethiopia [18] (89%, 90 %) but slightly lower than the study done in South Africa [5] (92 %) and Ethiopia [18] (94 %). The higher TSR in prison than the general population might be attributed to the maximum security prisons where the prisoners incarcerated for a longer sentences are bound to be within the prison and within reach of the wardens for the DOTS [17].…”

“…The 5.5 % death rate is comparable to the death rate observed in Uganda prison [6] but higher than the 1.4 % death rate recorded in Ethiopia [18], 1.8 % death rate recorded in South Africa [5]and 2 % death rate recorded in Brazil [4]. This high death rate could be attributed to the poor prison living conditions -overcrowding [19], poor nutrition [20] and possibly to the rate of HIV/TB co-infection without use of antiviral therapy (due to the lower coverage of antiretroviral therapy use during this time period), which has been shown to be associated with unsuccessful treatment outcome [13,21].…”

Loss to Follow-Up (LTFU) during Tuberculosis Treatment

“…Other populations of interest are prisoners and migrants. Northern Ethiopian prisons reported a low LTFU proportion of only 2.5% [63], which is an excellent result. In contrast, among the Ugandan prison inmates, 43% were LTFU and the odds are greater among the transferred prisoners [64].…”

Treatment outcomes of drug-susceptible tuberculosis and its predictors among male prison inmates in Bauchi State, Nigeria, 2014-2018

“…The cure rate in this study is higher than the studies conducted in Northern Ethiopian prisons and in North Shoa, Ethiopia but lower than that recorded in El-Salvador prison. 20,22,23 The low cure rate in this study compared to the El-Salvador study could be attributed to the lower sample size in this study and the high rates of loss to follow-up and transferred-out, since there was no system to track their progress, the final treatment outcomes of these patients were not known, so were not evaluated.…”

“…Duration of incarceration was significantly associated with successful treatment outcome, this is similar to the finding among inmates in Ethiopia prisons. 22 This similarity could be attributed to poor adherence to treatment protocol due to difficulty of prison life and mental stress associated with prolonged incarceration. The odds of successful treatment outcome increase with heavier body weight.…”