Katana Geoffrey G, Ngari Moses, Maina Teresia, Sanga Deche, Abdullahi Osman A
Department of Public Health, Pwani University, P.O Box 195-80108, Kilifi, Kenya.
Kilifi County Department of Public Health, Kilifi, Kenya.
Arch Public Health. 2022 Feb 5;80(1):48. doi: 10.1186/s13690-022-00807-4.
Tuberculosis (TB) is one of the leading causes of deaths in Africa, monitoring its treatment outcome is essential to evaluate treatment effectiveness. The study aimed to evaluate proportion of poor TB treatment outcomes (PTO) and its determinants during six-months of treatment at Kilifi County, Kenya.
We conducted a retrospective analysis of data from the TB surveillance system (TIBU) in Kilifi County, Kenya from 2012 to 2019. The outcome of interest was PTO (lost-to-follow-up (LTFU), death, transferred out, treatment failure, drug resistance) or successful treatment (cured or completed treatment). We performed time-stratified (at three months follow-up) survival regression analyses accounting for sub-county heterogeneity to determine factors associated with PTO.
We included 14,706 TB patients, their median (IQR) age was 37 (28-50) years and 8,791 (60%) were males. A total of 13,389 (91%) were on first line anti-TB treatment (2RHZE/4RH), 4,242 (29%) were HIV infected and 192 (1.3%) had other underlying medical conditions. During 78,882 person-months of follow-up, 2,408 (16%) patients had PTO: 1,074 (7.3%) deaths, 776 (5.3%) LTFU, 415 (2.8%) transferred out, 103 (0.7%) treatment failure and 30 (0.2%) multidrug resistance. The proportion of poor outcome increased from 7.9% in 2012 peaking at 2018 (22.8%) and slightly declining to 20% in 2019 (trend test P = 0.03). Over two-thirds 1,734 (72%) poor outcomes occurred within first three months of follow-up. In the first three months of TB treatment, overweight ((aHR 0.85 (95%CI 0.73-0.98), HIV infected not on ARVS (aHR 1.72 (95% CI 1.28-2.30)) and year of starting treatment were associated with PTO. However, in the last three months of treatment, elderly age ≥50 years (aHR 1.26 (95%CI 1.02-1.55), a retreatment patient (aHR 1.57 (95%CI 1.28-1.93), HIV infected not on ARVs (aHR 2.56 (95%CI 1.39-4.72), other underlying medical conditions (aHR 2.24 (95%CI 1.41-3.54)) and year of starting treatment were positively associated with PTO while being a female (aHR 0.83 (95%CI 0.70-0.97)) was negatively associated with PTO.
Over two-thirds of poor outcomes occur in the first three months of TB treatment, therefore greater efforts are needed during this phase. Interventions targeting HIV infected and other underlying medical conditions, the elderly and retreated patients provide an opportunity to improve TB treatment outcome.
结核病是非洲主要死因之一，监测其治疗结果对于评估治疗效果至关重要。本研究旨在评估肯尼亚基利菲县结核病治疗六个月期间不良治疗结果（PTO）的比例及其决定因素。
我们对肯尼亚基利菲县2012年至2019年结核病监测系统（TIBU）的数据进行了回顾性分析。感兴趣的结果是PTO（失访（LTFU）、死亡、转出、治疗失败、耐药）或成功治疗（治愈或完成治疗）。我们进行了时间分层（三个月随访时）生存回归分析，考虑了县以下的异质性，以确定与PTO相关的因素。
我们纳入了14706例结核病患者，他们的年龄中位数（IQR）为37（28 - 50）岁，8791例（60%）为男性。共有13389例（91%）接受一线抗结核治疗（2RHZE/4RH），4242例（29%）感染艾滋病毒，192例（1.3%）有其他基础疾病。在78882人月的随访期间，2408例（16%）患者出现PTO：1074例（7.3%）死亡，776例（
