Engoru Samuel, Bajunirwe Francis, Izudi Jonathan
Institute of Public Health and Management, Clarke International University, Kampala, Uganda.
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
J Clin Tuberc Other Mycobact Dis. 2024 Aug 12;37:100477. doi: 10.1016/j.jctube.2024.100477. eCollection 2024 Dec.
Multi-drug-resistant tuberculosis (MDR-TB) poses a significant public health challenge to the control and successful eradication of TB globally. Suboptimal treatment outcomes are common among persons with MDR-TB necessitating a need to understand the contextual factors.
We determined the factors associated with unsuccessful TB treatment among persons with MDR-TB at a large TB Unit in Central Uganda.
We retrospectively reviewed medical records for all persons with MDR-TB at Mubende Regional Referral Hospital MDR-TB Clinic in Central Uganda. The patients were treated with either second-line, modified second-line, or individualized anti-TB regimens and completed treatment between January 2012 and October 2023. The primary outcome was unsuccessful TB treatment defined as death, treatment failure, or loss to follow-up and measured as a binary outcome. We used a multivariable binary logistic regression analysis to determine the factors independently associated with unsuccessful TB treatment at a 5 % statistical significance level. We reported the adjusted odds ratio (aOR) and the 95 % confidence interval (CI).
We analyzed data from 98 persons with MDR-TB who were aged 15-78 years (mean 36.4 ± 15.4 years). Of these, 40 (40.8 %) were cured, 25 (25.5 %) completed TB treatment, 1 (1.0 %) had treatment failure, 13 (13.3 %) died, and 19 (19.4 %) were lost to follow-up. Overall, 33 (33.7 %) participants had unsuccessful TB treatment which was associated with older age for a 1-year increase in age (aOR 1.05, 95 % CI 1.01-1.09), malnutrition-mid-upper arm circumference of <12.5 cm (aOR 2.99, 95 % CI 1.16-7.98), and previous TB treatment (aOR 0.28, 95 % CI 0.10-0.77).
Unsuccessful TB treatment is high among persons with MDR-TB at this TB Unit. It is more likely as age advances and when persons with MDR-TB have malnutrition, but less likely when they have been previously treated for TB. Therefore, interventions to improve treatment outcomes may be beneficial for persons with MDR-TB who are older, malnourished, and those newly diagnosed with the disease. For example, routine nutritional assessment and counseling, including nutritional support for malnourished persons with MDR-TB may be needed to optimize their TB treatment success.
耐多药结核病（MDR-TB）对全球结核病的控制和成功消除构成了重大的公共卫生挑战。耐多药结核病患者的治疗效果欠佳很常见，因此有必要了解相关的背景因素。
我们确定了乌干达中部一家大型结核病治疗单位中耐多药结核病患者治疗未成功的相关因素。
我们回顾性分析了乌干达中部穆本德地区转诊医院耐多药结核病诊所所有耐多药结核病患者的病历。这些患者接受二线、改良二线或个体化抗结核治疗方案，并于2012年1月至2023年10月期间完成治疗。主要结局是治疗未成功，定义为死亡、治疗失败或失访，并作为二元结局进行衡量。我们使用多变量二元逻辑回归分析来确定在5%统计学显著性水平下与治疗未成功独立相关的因素。我们报告了调整后的优势比（aOR）和95%置信区间（CI）。
我们分析了98例年龄在15至78岁（平均36.4±15.4岁）的耐多药结核病患者的数据。其中，40例（40.8%）治愈，25例（25.5%）完成结核病治疗，1例（1.0%）治疗失败，13例（13.3%）死亡，19例（19.4%）失访。总体而言，33例（33.7%）参与者治疗未成功，这与年龄每增加1岁有关（aOR 1.05，95%CI 1.01-1.09），与营养不良（中上臂围<12.5厘米）有关（aOR 2.99，95%CI 1.16-7.98），与既往结核病治疗有关（aOR 0.28，95%CI 0.10-0.77）。
在这家结核病治疗单位，耐多药结核病患者治疗未成功的比例很高。随着年龄增长以及耐多药结核病患者出现营养不良时更有可能治疗未成功，但既往接受过结核病治疗时可能性较小。因此，改善治疗效果的干预措施可能对年龄较大、营养不良以及新诊断出该病的耐多药结核病患者有益。例如，可能需要进行常规营养评估和咨询，包括为营养不良的耐多药结核病患者提供营养支持，以优化他们的结核病治疗成功率。
