Factors Associated with Unfavourable Treatment Outcomes in Patients with Tuberculosis: A 16-Year Cohort Study (2005-2020), Republic of Karakalpakstan, Uzbekistan.

Jamshid Gadoev,Kallibek Kudaybergenov,Atadjan Hamraev,Masoud Dara,Lianne Kuppens,Martin Johan Boeree,Araksya Hovhannesyan,Damin Asadov,Anthony D Harries,Bakhtinur Khudanov,Oleksandr Korotych,Ajay M V Kumar,Askar Yedilbayev,Barno Abdusamatova

doi:10.3390/ijerph182312827

Abstract

Tuberculosis (TB) remains a public health burden in the Republic of Karakalpakstan, Uzbekistan. This region-wide retrospective cohort study reports the treatment outcomes of patients registered in the TB electronic register and treated with first-line drugs in the TB Programme of the Republic of Karakalpakstan from 2005–2020 and factors associated with unfavourable outcomes. Among 35,122 registered patients, 24,394 (69%) patients were adults, 2339 (7%) were children, 18,032 (51%) were male and 19,774 (68%) lived in rural areas. Of these patients, 29,130 (83%) had pulmonary TB and 7497 (>22%) had been previously treated. There were 7440 (21%) patients who had unfavourable treatment outcomes. Factors associated with unfavourable treatment outcomes included: increasing age, living in certain parts of the republic, disability, pensioner status, unemployment, being HIV-positive, having pulmonary TB, and receiving category II treatment. Factors associated with death included: being adult and elderly, living in certain parts of the republic, having a disability, pensioner status, being HIV-positive, and receiving category II treatment. Factors associated with failure included: being adolescent, female, having pulmonary TB. Factors associated with loss to follow-up included: being male, disability, pensioner status, unemployment, receiving category II treatment. In summary, there are sub-groups of patients who need special attention in order to decrease unfavourable treatment outcomes.

Highlights

Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the top 10 causes of death in lower-middle income countries
Increasing age, living in certain parts of the Republic, disability, pensioner status, unemployment, being HIV-positive, having pulmonary TB, and receiving category II treatment were independent factors that increased the risk of unfavorable treatment outcomes of patients who were initiated on first-line TB treatment in the Republic of Karakalpakstan
Factors associated with death included: being adult and elderly, living in certain parts of the Republic, disability, pensioner status, being HIV-positive, and receiving category II

Summary

Introduction

Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the top 10 causes of death in lower-middle income countries. TB is caused by the bacillus Mycobacterium tuberculosis, which is spread when people who are sick with TB expel bacteria into the air; for example, by coughing. The disease typically affects the lungs (pulmonary TB) but can affect other sites (extrapulmonary TB) [1]. TB remains a public health burden in central Asian countries, in Uzbekistan. The World Health Organization (WHO) in 2019 estimated the TB incidence in Uzbekistan to be 69 per 100,000 population [1]. Uzbekistan is among the top 30 countries in the world with multidrug-resistant TB (MDR-TB, resistant to at least isoniazid and rifampicin) and one of the 18 high-priority TB burden countries in the WHO European

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