Abstract
BackgroundThe World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. However, mortality due to multidrug-resistant tuberculosis (MDR-TB) remains particularly high. Globally, almost 20% of patients started on MDR-TB treatment die during the course of treatment every year. We set out to examine the risk factors for mortality among a cohort of patients diagnosed with MDR-TB in Uganda.MethodsWe conducted a case-control study nested within the national MDR-TB cohort. We defined cases as patients who died from any cause during the course of MDR-TB treatment. We selected two controls for each case from patients alive and on MDR-TB treatment at the time that the death occurred (incidence-density sampling). We matched the cases and controls on health facility at which they were receiving care. We performed conditional logistic regression to identify the risk factors for mortality.ResultsData from 198 patients (66 cases and 132 controls) started on MDR-TB treatment from January 1 to December 31, 2016, was analyzed for this study. Cases were similar to controls in age/sex distribution, occupation and history of TB treatment. However, cases were more likely to be HIV infected while controls were more likely to have attained secondary level education. On multivariate regression analysis, co-infection with HIV (aOR 1.9, 95% CI [1.1–4.92] p = 0.05); non-adherence to MDR-TB treatment (aOR 1.92, 95% CI [1.02–4.83] p = 0.04); age over 50 years (aOR 3.04, 95% CI [1.13–8.20] p = 0.03); and having no education (aOR 3.61, 95% CI [1.1–10.4] p = 0.03) were associated with MDR-TB mortality.ConclusionTo mitigate MDR-TB mortality, attention must be paid to provision of social support particularly for older persons on MDR-TB treatment. In addition, interventions that support treatment adherence and promote early detection and management of TB among HIV infected persons should also be emphasized.
Highlights
The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035
To mitigate multidrug-resistant tuberculosis (MDR-TB) mortality, attention must be paid to provision of social support for older persons on MDR-TB treatment
Risk factors for mortality while on MDR-TB treatment were; patients' education level OR 3.70, 95% CI [1.5–8.0] p = 0.02; age >50 years OR 2.51, 95% CI [0.98–6.42] p = 0.06; HIV co-infection OR 1.83, 95% CI [0.86–2.70] p = 0.07; having missed doses 1.71, 95% CI [0.6–3.40] p = 0.22 and having a documented medical complication OR 1.82, 95% CI [0.97–3.40] p = 0.05 (Table 2)
Summary
The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. Almost 20% of patients started on MDR-TB treatment die during the course of treatment every year. In 2019, the World Health Organization (WHO) estimated that only about 35% of the estimated 500,000 incident cases of MDR-TB were started on an appropriate MDR-TB treatment regimen [3] Among cohorts of patients on treatment, treatment outcomes have consistently been suboptimal. In 2019, only 57% of patients started on MDR-TB treatment 2 years earlier (2017) successfully completed treatment [3]. HIV co-infection among MDR-TB patients remains high (30% MDR-TB/HIV coinfection in the 2019 cohort) and like the rest of the world, treatment outcomes are suboptimal. Two thirds of those started on MDR-TB treatment in 2017 successfully completed treatment with 20% of all patients dying during the course of therapy [6]
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