Comparative assessment of Directly Observed Treatment Short-course (DOTS) for tuberculosis patients in a primary and a tertiary health centre in Nigeria

Abstract

Nasarawa State, Nigeria has HIV prevalence of 7.5%. This is capable of fueling and worsening the tuberculosis/HIV epidemic. This study compared TB treatment outcomes between a primary health care and a tertiary health centre; it assessed the overlap between TB and HIV. A cross-sectional retrospective design was adopted. Data from the directly observed treatment register for 15 months was abstracted from both facilities. A total of 1678 TB patients files were assessed; the tertiary health centre accounted for 33% of the TB population while the primary health care centre represented two-thirds. Of the 75% of TB patients who had HIV testing, about 48% were HIV positive. Primary health care facility achieved statistically significant outcomes in cured (43%) representing 86.8% of cured outcome within program, p-value 0.000; treatment completed of 46.1% representing 60.4%, p-value 0.000; and had the least case of treatment default, 1.7% which accounted for 18%, p-value 0.000 while the tertiary health facility attained better outcomes in treatment failure and death rates p-value 0.013 and 0.033 respectively. With an overall successful treatment outcome of about 84%; the primary health care centre recorded successful treatment outcome of 89% compared to tertiary health facility which achieved 73%. The overlap between TB and HIV was high. Comparatively, treatment outcomes were significantly better at primary health centre. Keywords : DOTS; Tuberculosis; HIV; Nigeria