Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
National Tuberculosis and Leprosy Program, Ministry of Health, Dodoma, Tanzania.
PLoS Negl Trop Dis. 2024 Feb 15;18(2):e0011968. doi: 10.1371/journal.pntd.0011968. eCollection 2024 Feb.
Patients with recurrent TB have an increased risk of higher mortality, lower success rate, and a relatively feeble likelihood of treatment completion than those with new-onset TB. This study aimed to assess the epidemiology of recurrent TB in Tanzania; specifically, we aim to determine the prevalence of TB recurrence and factors associated with unfavourable treatment outcomes among patients with recurrent TB in Tanzania from 2018 to 2021.
In this cross-sectional study, we utilized Tanzania's routinely collected national TB program data. The study involved a cohort of TB patients over a fixed treatment period registered in the TB and Leprosy case-based District Health Information System (DHIS2-ETL) database from 2018 to 2021 in Tanzania. We included patients' sociodemographic and clinical factors, facility characteristics, and TB treatment outcomes. We conducted bivariate analysis and multivariable multi-level mixed effects logistic regression of factors associated with TB recurrence and TB treatment outcomes to account for the correlations at the facility level. A purposeful selection method was used; the multivariable model included apriori selected variables (Age, Sex, and HIV status) and variables with a p-value <0.2 on bivariate analysis. The adjusted odds ratio and 95% confidence interval were recorded, and a p-value of less than 0.05 was considered statistically significant.
A total of 319,717 participants were included in the study; the majority were adults aged 25-49 (44.2%, n = 141,193) and above 50 years (31.6%, n = 101,039). About two-thirds were male (60.4%, n = 192,986), and more than one-fifth of participants (22.8%, n = 72,396) were HIV positive. Nearly two in every hundred TB patients had a recurrent TB episode (2.0%, n = 6,723). About 10% of patients with recurrent TB had unfavourable treatment outcomes (9.6%, n = 519). The odds of poor treatment outcomes were two-fold higher for participants receiving treatment at the central (aOR = 2.24; 95% CI 1.33-3.78) and coastal zones (aOR = 2.20; 95% CI 1.40-3.47) than the northern zone. HIV-positive participants had 62% extra odds of unfavourable treatment outcomes compared to their HIV-negative counterparts (aOR = 1.62; 95% CI 1.25-2.11). Bacteriological TB diagnosis (aOR = 1.39; 95% CI 1.02-1.90) was associated with a 39% additional risk of unfavourable treatment outcomes as compared to clinical TB diagnosis. Compared to community-based DOT, patients who received DOT at the facility had 1.39 times the odds of poor treatment outcomes (aOR = 1.39; 95%CI 1.04-1.85).
TB recurrence in Tanzania accounts for 2% of all TB cases, and it is associated with poor treatment outcomes. Unfavourable treatment outcomes were recorded in 10% of patients with recurrent TB. Poor TB treatment outcome was associated with HIV-positive status, facility-based DOT, bacteriologically confirmed TB and receiving treatment at the hospital level, differing among regions. We recommend post-treatment follow-up for patients with recurrent TB, especially those coinfected with HIV. We also propose close follow-up for patients treated at the hospital facility level and strengthening primary health facilities in TB detection and management to facilitate early treatment initiation.
复发结核病患者的死亡率更高、成功率更低，且完成治疗的可能性相对较低，与新发结核病患者相比。本研究旨在评估坦桑尼亚复发性结核病的流行病学；具体来说，我们旨在确定 2018 年至 2021 年期间坦桑尼亚复发性结核病患者的复发率以及与不利治疗结果相关的因素。
在这项横断面研究中，我们利用了坦桑尼亚常规收集的国家结核病规划数据。该研究涉及 2018 年至 2021 年期间在坦桑尼亚结核病和麻风病基于病例的地区卫生信息系统（DHIS2-ETL）数据库中登记的固定治疗期内的结核病患者队列。我们纳入了患者的社会人口统计学和临床因素、医疗机构特征和结核病治疗结果。我们进行了双变量分析和多变量多水平混合效应逻辑回归分析，以确定与结核病复发和结核病治疗结果相关的因素，以考虑到医疗机构层面的相关性。采用有目的的选择方法；多变量模型包括先验选择的变量（年龄、性别和 HIV 状况）和双变量分析中 p 值<0.2 的变量。记录了调整后的优势比和 95%置信区间，p 值<0.05 被认为具有统计学意义。
共有 319717 名参与者纳入研究；大多数是 25-49 岁（44.2%，n=141193）和 50 岁以上（31.6%，n=101039）的成年人。大约三分之二是男性（60.4%，n=192986），超过五分之一的参与者（22.8%，n=72396）是 HIV 阳性。每一百名结核病患者中几乎有两人患有复发性结核病（2.0%，n=6723）。约 10%的复发性结核病患者治疗结果不佳（9.6%，n=519）。与北部地区相比，在中央和沿海地区（aOR=2.24；95%CI 1.33-3.78；aOR=2.20；95%CI 1.40-3.47）接受治疗的参与者治疗结果不佳的可能性高两倍。与 HIV 阴性者相比，HIV 阳性参与者治疗结果不佳的可能性增加 62%（aOR=1.62；95%CI 1.25-2.11）。与临床结核病诊断相比，细菌学结核病诊断（aOR=1.39；95%CI 1.02-1.90）与治疗结果不佳的风险增加 39%相关。与社区为基础的直接督导下治疗（DOT）相比，在医疗机构接受 DOT 的患者治疗结果不佳的可能性增加 1.39 倍（aOR=1.39；95%CI 1.04-1.85）。
坦桑尼亚的结核病复发占所有结核病病例的 2%，与治疗结果不佳有关。10%的复发性结核病患者治疗结果不佳。不良的结核病治疗结果与 HIV 阳性状态、医疗机构为基础的 DOT、细菌学确诊的结核病以及在医院级别接受治疗有关，在不同地区有所不同。我们建议对复发性结核病患者进行治疗后随访，特别是对 HIV 合并感染的患者。我们还建议对在医院设施级别接受治疗的患者进行密切随访，并加强初级卫生设施在结核病检测和管理方面的工作，以促进早期治疗的启动。
