Abstract
Background: Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high. We evaluated baseline patient factors as predictors of poor DSTB treatment outcomes. Methods: We conducted a retrospective analysis of new drug sensitive pulmonary TB patients treated in Kyiv Oblast, Ukraine between November 2012 and October 2014. We defined good treatment outcomes as cure or completion and poor outcomes as death, default (lost to follow up) or treatment failure. We performed logistic regression analyses, using routine program data, to identify baseline patient factors associated with poor outcomes. Results: Among 302 patients, 193 (63.9%) experienced good treatment outcomes while 39 (12.9%) failed treatment, 34 (11.3%) died, and 30 (9.9%) were lost to follow up. In the multivariate analysis, HIV positive patients on anti-retroviral therapy (ART) [OR 3.50; 95% CI 1.46 – 8.42; p 0.005] or without ART (OR 4.12; 95% CI 1.36 – 12.43; p 0.01) were at increased risk of poor outcomes. Frequent alcohol use (OR 1.81; 95% CI 0.93 - 3.55; p 0.08) and smear positivity (OR 1.75; 95% CI 1.03 - 2.97; p 0.04) were also associated with poor treatment outcomes. Conclusions: High rates of poor outcomes among patients with newly diagnosed drug sensitive TB in Kyiv Oblast, Ukraine highlight the urgent need for programmatic interventions, especially aimed at patients with the highest risk of poor outcomes.
Highlights
Tuberculosis (TB) control remains challenging worldwide, with approximately 10.6 million new cases diagnosed and 1.6 million TB deaths in 20161
Incidence rates have declined in parts of Eastern Europe, TB continues to be a significant public health problem in many former Soviet Union countries including Ukraine, which currently has the second highest burden of multi-drug resistant TB (MDR-TB) in the WHO European Region after Russia[1]
The 2014 Ukraine’s National TB Program (UNTP) specify the following: baseline susceptibility testing to rifampin (R), isoniazid (H), ethambutol (E), pyrazinamide (Z) and streptomycin (S) on all culture positive TB isolates; baseline screening for pre-specified risk factors including frequent alcohol use, intravenous drug use (IVDU), and homelessness; baseline HIV testing and provision of anti-retroviral therapy (ART) to those that are positive as soon as possible after initiation of TB treatment; and repeat drug susceptibility testing (DST) among drug sensitive tuberculosis (DSTB) patients who are culture positive at three months or at the end of treatment
Summary
Tuberculosis (TB) control remains challenging worldwide, with approximately 10.6 million new cases diagnosed and 1.6 million TB deaths in 20161. Surveillance for resistant TB includes routine drug susceptibility testing (DST) for all culture positive isolates; and in 2007 the country adopted WHO recommended directly observed therapy short course (DOTS). Despite these efforts, Ukraine’s National TB Program (UNTP) still has low treatment success rates. According to the most recent WHO data available for new smear and/or culture positive TB cases in Ukraine, the treatment success rate among these cases was 58% in 2011 in contrast to a global success rate of 83%3. Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high. Conclusions: High rates of poor outcomes among patients with newly diagnosed drug sensitive TB in Kyiv Oblast, Ukraine highlight the version 3 (revision)
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