Predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
19
02
2019
accepted:
02
10
2019
entrez:
31
10
2019
pubmed:
31
10
2019
medline:
17
3
2020
Statut:
epublish
Résumé
Multidrug-resistant tuberculosis (MDR-TB) is a man-made problem when bacteria are resistant to at least two anti TB drugs (Rifampicin and Isoniazid). Currently from tuberculosis infected patients, two out of ten are developing MDR-TB and it is an emerging public health problem in Ethiopia. Despite high burden of MDR-TB in Ethiopia, the treatment outcomes and predictors related to incidence among MDR-TB patients is not studied in Oromia region, Ethiopia. Therefore, the present study assessed the predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia. Facility based retrospective cohort study was conducted at hospitals in Oromia Region. All registered MDR-TB patient charts from 2015 to 2017 were considered for the study. Data entry was done by using EPI data version 3.1 Statistical Software and data analysis was done by SPSS version 20. The descriptive statistics, frequency, median and range were employed. Bivariate and multivariate Cox proportional hazard regression analysis was used to identify predictors of time to unfavorable treatment outcomes of multidrug resistant tuberculosis. In multivariate Cox proportional hazard regression analysis, the variables with P- value less than and equal to 0.05 were considered as predictor variables for time to unfavorable treatment outcome of MDR-TB. From the total of 415 (92.84%) complete MDR-TB charts, the overall cumulative probability of unfavorable treatment outcome at the end of the treatment (two years) was 21.21%. In multivariate Cox proportional hazard analysis initial culture result [AHR = 0.52; 95% CI: 0.29, 0.96], HIV test result [AHR = 3.76; 95% CI: 2.45, 5.78] and culture at the end of continuation phases [AHR = 0.12; 95% CI: 0.08, 0.20] were the predictors of unfavorable treatment outcome. The magnitude of unfavorable treatment outcome at Oromia hospitals was lower than WHO regional report of 2018. This finding demonstrated that low unfavorable treatment outcomes for MDR-TB patients can be achieved in a resource-constrained and high TB-burden setting. Whereas, Initial culture result, HIV test result and culture at the end of continuation phases were determined as predictor factors with associated unfavorable treatment outcomes. Culture positive and HIV positive MDR-TB patients need special attention at the time of treatment.
Sections du résumé
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) is a man-made problem when bacteria are resistant to at least two anti TB drugs (Rifampicin and Isoniazid). Currently from tuberculosis infected patients, two out of ten are developing MDR-TB and it is an emerging public health problem in Ethiopia. Despite high burden of MDR-TB in Ethiopia, the treatment outcomes and predictors related to incidence among MDR-TB patients is not studied in Oromia region, Ethiopia. Therefore, the present study assessed the predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia.
METHOD
Facility based retrospective cohort study was conducted at hospitals in Oromia Region. All registered MDR-TB patient charts from 2015 to 2017 were considered for the study. Data entry was done by using EPI data version 3.1 Statistical Software and data analysis was done by SPSS version 20. The descriptive statistics, frequency, median and range were employed. Bivariate and multivariate Cox proportional hazard regression analysis was used to identify predictors of time to unfavorable treatment outcomes of multidrug resistant tuberculosis. In multivariate Cox proportional hazard regression analysis, the variables with P- value less than and equal to 0.05 were considered as predictor variables for time to unfavorable treatment outcome of MDR-TB.
RESULT
From the total of 415 (92.84%) complete MDR-TB charts, the overall cumulative probability of unfavorable treatment outcome at the end of the treatment (two years) was 21.21%. In multivariate Cox proportional hazard analysis initial culture result [AHR = 0.52; 95% CI: 0.29, 0.96], HIV test result [AHR = 3.76; 95% CI: 2.45, 5.78] and culture at the end of continuation phases [AHR = 0.12; 95% CI: 0.08, 0.20] were the predictors of unfavorable treatment outcome.
CONCLUSION
The magnitude of unfavorable treatment outcome at Oromia hospitals was lower than WHO regional report of 2018. This finding demonstrated that low unfavorable treatment outcomes for MDR-TB patients can be achieved in a resource-constrained and high TB-burden setting. Whereas, Initial culture result, HIV test result and culture at the end of continuation phases were determined as predictor factors with associated unfavorable treatment outcomes. Culture positive and HIV positive MDR-TB patients need special attention at the time of treatment.
Identifiants
pubmed: 31665154
doi: 10.1371/journal.pone.0224025
pii: PONE-D-19-04904
pmc: PMC6821088
doi:
Substances chimiques
Antitubercular Agents
0
Isoniazid
V83O1VOZ8L
Rifampin
VJT6J7R4TR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0224025Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Euro Surveill. 2013 Oct 03;18(40):null
pubmed: 24128699
Glob Health Action. 2015 Nov 24;8:29019
pubmed: 26610316
Trop Med Int Health. 2010 Sep;15(9):1052-66
pubmed: 20545927
J Infect Public Health. 2016 Jul-Aug;9(4):478-84
pubmed: 26724262
Trop Med Int Health. 2017 Mar;22(3):351-362
pubmed: 27978594
BMC Infect Dis. 2017 Aug 16;17(1):573
pubmed: 28814276
Lancet Respir Med. 2017 Mar 15;:null
pubmed: 28344011
Int J Tuberc Lung Dis. 2015 Dec;19(12):1524-7
pubmed: 26614196
J Formos Med Assoc. 2016 Nov;115(11):997-1003
pubmed: 26696497
Emerg Infect Dis. 2014 May;20(5):812-21
pubmed: 24751166
Tuberculosis (Edinb). 2012 Sep;92(5):397-403
pubmed: 22789497
Swiss Med Wkly. 2014 Dec 04;144:w14053
pubmed: 25474040
Int J Tuberc Lung Dis. 2012 Jan;16(1):90-7
pubmed: 22236852
Emerg Infect Dis. 2016 Mar;22(3):491-502
pubmed: 26889786
Chest. 2006 Jul;130(1):261-72
pubmed: 16840411
Thorax. 2015 Dec;70(12):1181-8
pubmed: 26506854