A four-year trend in pulmonary bacteriologically confirmed tuberculosis case detection in Kampala-Uganda

Nicholas Sebuliba Kirirabwa,Raymond Byaruhanga,Samuel Kasozi,Denis Sama,Derrick Kimuli,Daniel Ayen Okello,Deus Lukoye,Syrus Ntudhu,Carol Nanziri

doi:10.1186/s12890-019-0853-3

Nicholas Sebuliba Kirirabwa, Raymond Byaruhanga + Show 7 more

Open Access

https://doi.org/10.1186/s12890-019-0853-3

Copy DOI

Abstract

BackgroundThe management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also known as infectious TB is important not only to monitor for resistance but also to check for severity, treatment response and limit its spread.MethodA retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done.ResultsOf the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. Sputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert testing, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acid-fast bacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194 (p = 0.000). The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597(43%) to 890(40.6%) (p = 0.000) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015 (p = 0.000). The treatment success rate (TSR) for PBC TB patients improved from 69% in 2012 to 75.5% by end of 2015 (p = 0.001) with an improvement in cure rate from 52.3% to 62% (p = 0.000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% (p = 0.013).ConclusionThe proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may elucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many people a single PBC TB patient is likely to infect with TB before being diagnosed and treated.

Highlights

The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) known as infectious TB is important to monitor for resistance and to check for severity, treatment response and limit its spread
About 74.9% of all PBC TB patients were diagnosed by sputum smear microscopy test, 15.6% were diagnosed by GeneXpert testing, and only four patients (0.1%) were diagnosed by culture testing
Our research showed a statistically significant increase in GeneXpert testing through the years and this could have influenced the increasing trend of PBC TB patients observed during our study period

Summary

Introduction

The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) known as infectious TB is important to monitor for resistance and to check for severity, treatment response and limit its spread. The first of which was the Directly Observed Treatment Short Course (DOTS) strategy, which allows patients to take their daily drugs under the observation of health professionals, thereby improving treatment compliance and increasing the cure rate [7, 8]. This was replaced by the more comprehensive Stop TB Strategy implemented in 2006, followed by the End TB Strategy in 2015, to address the emerging challenges of drug-resistant TB, TB/HIV co-infection and the incorporation of new diagnostic tests, such as GeneXpert [9]

Methods

Results

Discussion

Conclusion