Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
PLoS One. 2018 Mar 19;13(3):e0194675. doi: 10.1371/journal.pone.0194675. eCollection 2018.
Knowledge of tuberculosis (TB) treatment outcomes is substantially needed to assess the performance of national TB controls programs (NTPs). To date, the overall estimates of treatment outcomes have not been determined in Ethiopia. Therefore, this meta-analysis was undertaken to produce pooled estimates of TB treatment outcomes and to analyze the impact of prior anti-TB drug exposure and HIV co-infection.
Potentially relevant studies were retrieved from PubMed, EMBASE, and MEDLINE online databases. The unpublished studies have been retrieved from the grey literature through Google and Google Scholar. The pooled estimates were calculated using random effect model. The summary estimates were also presented using Forest plots and Tables. The outcome measures were successful and unsuccessful treatment outcomes. Patients who were cured or with completed treatment defined as successful treatment outcome and patients meeting the definition of death, defaulting and failure are considered as unsuccessfully treated cases.
A total of 34 studies are included for meta-analysis. The pooled estimate of successful TB treatment outcomes amounts to 83.7% (95% CI 81.1%-86.3%). Of successfully treated cases, 33.9% were cured and the remaining completed cases. Besides, among patients with unsuccessful treatment outcome, nearly 50% were dead and the rest were treatment failures and defaulters. Sub-group analysis shows that high treatment success rate was estimated in Afar; 88.9% (95% CI 83.8%-94.2%), followed by Oromia; 88.5% (95% CI 82.6%-94.5%) and Gambella; 86.1% (95% CI 84.4%-87.9%), whereas relatively poor treatment outcome was noted in Tigray; 20.0% (95% CI 2.1%-37.9%) and Amhara; 19.0% (95% CI 12.6%-25.5%). The unsuccessful TB treatment outcome was found to be higher among HIV/TB co-infected cases with an odds ratio of 1.98 (95%CI, 1.56-2.52) and re-treated cases with an odds ratio of 2.17 (95%CI, 1.55-3.03). The time trend was assessed from 2003 to 2016, but it shows insignificant variation with treatment outcome (P = 0.108).
The rate of successful treatment outcome in Ethiopia appears generally high, only slightly below the threshold suggested by the World Health Organization. History of tuberculosis treatment and HIV/TB co-infection were inversely associated with favorable treatment outcomes.
了解结核病（TB）治疗结果对于评估国家结核病控制规划（NTP）的表现至关重要。迄今为止，尚未在埃塞俄比亚确定总体治疗结果的估计数。因此，进行了这项荟萃分析，以得出结核病治疗结果的汇总估计数，并分析先前抗结核药物暴露和 HIV 合并感染的影响。
从 PubMed、EMBASE 和 MEDLINE 在线数据库中检索潜在相关研究。通过 Google 和 Google Scholar 从灰色文献中检索未发表的研究。使用随机效应模型计算汇总估计值。使用森林图和表格也呈现了汇总估计值。结局测量是成功和不成功的治疗结局。治愈或完成治疗的患者定义为成功治疗结局，符合死亡、失访和失败定义的患者视为治疗失败。
共有 34 项研究纳入荟萃分析。成功的结核病治疗结果的汇总估计数为 83.7%（95%CI 81.1%-86.3%）。在成功治疗的病例中，33.9%为治愈，其余为完成治疗的病例。此外，在治疗失败的病例中，近 50%为死亡，其余为治疗失败和失访。亚组分析显示，在阿法尔地区估计治疗成功率较高，为 88.9%（95%CI 83.8%-94.2%），其次是奥罗米亚地区，为 88.5%（95%CI 82.6%-94.5%）和甘贝拉地区，为 86.1%（95%CI 84.4%-87.9%），而在提格雷地区则观察到相对较差的治疗结果，为 20.0%（95%CI 2.1%-37.9%）和阿姆哈拉地区，为 19.0%（95%CI 12.6%-25.5%）。HIV/TB 合并感染的结核病治疗失败的可能性更高，比值比为 1.98（95%CI，1.56-2.52），复治的比值比为 2.17（95%CI，1.55-3.03）。从 2003 年到 2016 年评估了时间趋势，但与治疗结果无显著变化（P = 0.108）。
埃塞俄比亚的治疗成功比例似乎普遍较高，仅略低于世界卫生组织建议的阈值。结核病治疗史和 HIV/TB 合并感染与有利的治疗结果呈负相关。
