Intensive phase treatment outcome and associated factors among patients treated for multi drug resistant tuberculosis in Ethiopia: a retrospective cohort study
Tóm tắt
Multi-drug resistant Tuberculosis (MDR-TB) is a strain of Mycobacterium tuberculosis that is resistant to at least Rifampicin and Isoniazid drugs. The treatment success rate for MDR-TB cases is lower than for drug susceptible TB. Globally only 55% of MDR-TB patients were successfully treated. Monitoring the early treatment outcome and better understanding of the specific reasons for early unfavorable and unknown treatment outcome is crucial for preventing the emergence of further drug-resistant tuberculosis. However, this information is scarce in Ethiopia. Therefore, this study aimed to determine the intensive phase treatment outcome and contributing factors among patients treated for MDR-TB in Ethiopia. A 6 year retrospective cohort record review was conducted in fourteen TICs all over the country. The records of 751 MDR-TB patients were randomly selected using simple random sampling technique. Data were collected using a pre-tested and structured checklist. Multivariable multinomial logistic regression was undertaken to identify the contributing factors. At the end of the intensive phase, 17.3% of MDR-TB patients had an unfavorable treatment outcome, while 16.8% had an unknown outcome with the remaining having a favorable outcome. The median duration of the intensive phase was 9.0 months (IQR 8.04–10.54). Having an unfavorable intensive phase treatment outcome was found significantly more common among older age [ARRR = 1.047, 95% CI (1.024, 1.072)] and those with a history of hypokalemia [ARRR = 0.512, 95% CI (0.280, 0.939)]. Having an unknown intensive phase treatment outcome was found to be more common among those treated under the ambulatory care [ARRR = 3.2, 95% CI (1.6, 6.2)], rural dwellers [ARRR = 0.370, 95% CI (0.199, 0.66)], those without a treatment supporter [ARRR = 0.022, 95% CI (0.002, 0.231)], and those with resistance to a limited number of drugs. We observed a higher rate of unfavorable and unknown treatment outcome in this study. To improve favorable treatment outcome more emphasis should be given to conducting all scheduled laboratory monitoring tests, assignment of treatment supporters for each patient and ensuring complete recording and reporting which could be enhanced by quarterly cohort review. Older aged and rural patients need special attention. Furthermore, the sample referral network should be strengthened.
Tài liệu tham khảo
WHO. Multidrug-resistant tuberculosis Global TB report Update www.who.int/tb. 2013.
FMOH-E. Training material on programmatic management of drug resistant tuberculosis in Ethiopia for general health care workers. Ethiopia: Addis Ababa; 2013.
WHO. Multidrug and extensively drug-resistant TB: global report on surveillance and response. Geneva, Switzerland; 2017.
WHO. Multidrug and extensively drug-resistant TB: global report on surveillance and response. Geneva, Switzerland; 2018.
FMOH-E. TBL, TB/HIV and MDR-TB: national annual performance report, unpublished. Addis Ababa, Ethiopia; 2018.
FMOH-E. TBL, TB/HIV and MDR-TB: national annual performance report, unpublished. Addis Ababa, Ethiopia; 2015.
WHO. Guidelines for the programmatic management of drug-resistant tuberculosis. In: Who/HTM/TB/2008, vol. 402. Switzerland: Geneva; 2008.
WHO. Anti-tuberculosis Drug resistance in the World. Report No.4. (WHO/HTM/TB/2008.394) WHO, Geneva, Switzerland. 2008.
FMOH-E. Guidelines on programmatic management of drug resistant tuberculosis in Ethiopia for general health care workers 2nd edition October. Ethiopia: Addis Ababa; 2014.
Temple B, Ayakaka I, Ogwang S, Nabanjja H, Edward C. Rate and amplification of drug resistance among previously-treated patients with tuberculosis. Clin Infect Dis. 2008.
Holtz TH, Sternberg M, Kammerer S, Laserson KF, Riekstina V. Time to sputum Culture conversion in multidrug-resistant tuberculosis: predictors and relationship to treatment outcome. Ann Intern Med. 2006;144:650–9.
Qazi F, Khan U, Khowaja S, Javaid M, Ahmed A. Predictors of delayed culture conversion in patients treated for multidrug-resistant tuberculosisin Pakistan. Int J Tuberc Lung Dis. 2011;15:1556–60.
Kurbatova EV, Gammino VM, Bayona J, Becerra MC, Danilovitz M, Falzon D. Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis. Int J Tubercul Lung Dis. 2012;16(10):1335–43.
Brust JCM, Berman AR, Zalta B, Haramat LB, Gandhi NR. Chest radiograph findings and time to culture conversion in patients with multidrug-resistant tuberculosis and HIV in Tugela ferry, South Africa. PLoS One. 2013;8(9):e73975.
Brust JCM, Lygizos M, Chaiyachati K, Scott M, van der Merwe TL. Culture conversion among HIV co-infected multidrug-resistant tuberculosis patients in Tugela ferry, South Africa. PLoS ON. 2014;6(1):e15841.
Gandhi NR, Andrews JR, Brust JC, Montreuil R, Weissman D, Heo M. Risk factors for mortality among MDR and XDR-TB patients in a high HIV-prevalence setting in South Africa. Int J Tuberc Lung Dis. 2012;16(1):90–7.
Federal Democratic Republic of Ethiopia Population Census Commission (FDRE-PCC). Summary and Statistical report of the population and housing census result. 2007.
Seung KJ, Omatayo DB, Keshavjee S, Furin JJ, Farmer PE, Hind S. Early outcomes of MDR-TB treatment in a high HIV-prevalence setting in southern Africa. PLoSONE. 2009;4(9):e7186.
Daniel W.W. A foundation for analysis in health science. Biostatistics. Seventh edition. Georgia State University, New York, USA. John Wiley & Sons, Ltd. 1999.
Hosmer D w, Stanley L. Applied logistic regression. 3rd ed; 2013.
Oladimeji O, Isaakidis P, Obasanya OJ, Eltayeb O, Khogali M. Intensive-phase treatment outcomes among hospitalized multidrug-resist ant tuberculosis patients: results from a Nationwide cohort in Nigeria. PLoS One. 2014;9(4):e94393.
Hafkin J, Modongo C, Newcomb C, Lowentha E. Impact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana. 2013. https://doi.org/10.5588/ijtld.12.0100. Accessed on 3 Nov 2014.
He GX, Xie YG, Wang LX, Borgdorff MW, van der Werf MJ. Follow-up of patients with multidrug resistant tuberculosis four years after standardized first-line drug treatment. PLoS One. 2011;5(5):e10799.
Isaakidis P, Cox HS, Varghese B, Montaldo C, Da Silva E. Ambulatory multi-drug resistant tuberculosis treatment outcomes in a cohort of HIV-infected patients in a slum setting in Mumbai, India. PLoS One. 2011;6(12):e28066.
Mpagama SG, Heysell SK, Ndusilo ND, Kumburu HH, Lekule IA. Diagnosis and interim treatment outcomes from the first cohort of multidrug resistant tuberculosis patients in Tanzania. PLo S ONE. 2013;8(5):e62034.