Abstract
BackgroundTuberculosis (TB) continues to be a major global health problem. While progress has been made to improve TB cure rates, South Africa’s 76 % smear-positive pulmonary TB (PTB) case cure rate remains below the WHO target of 85 %. We report on the trends of TB smear non-conversion and their predictors at the end of an intensive phase of treatment, and how this impacted on treatment outcomes of smear-positive PTB cases in Eden District, Western Cape Province, South Africa.MethodsRoutinely collected, retrospective data of smear-positive PTB cases from the electronic TB register in Eden District between 2007 and 2013 was extracted. Non-conversion was defined as persistent sputum smear-positive PTB cases at the end of the two or three month intensive phase of treatment. Chi-square test for linear trend and simple linear regression analysis were used to analyse the change in percentages and slope of TB smear non-conversion rates over time. Risk factors for TB non-conversion, and their impact on treatment outcomes, were evaluated using logistic regression models.ResultsOf 12,742 total smear-positive PTB cases included in our study, 12.8 % (n = 1627) did not sputum smear convert; 13.3 % (1411 of 10,574) of new cases and 9.9 % (216 of 2168) of re-treatment cases. Although not statistically significant in either new or re-treatment cases, between 2007 and 2013, smear non-conversion decreased from 16.4 to 12.7 % (slope = −0.60; 95 % CI: −1.49 to 0.29; p = 0.142) in new cases, and from 11.3 to 10.8 % in re-treatment cases (slope = −0.29; 95 % CI: −1.06 to 0.48; p = 0.376). Male gender, HIV co-infection and a >2+ acid fast bacilli (AFB) smear grading at the start of TB treatment were independent risk factors for non-conversion (p < 0.001). Age was a risk factor for non-conversion in new cases, but not for re-treatment cases. Non-conversion was also associated with unsuccessful treatment outcomes (p < 0.01), including treatment default and treatment failure.ConclusionsSmear-positive PTB cases, especially men and those with identified risk factors for non-conversion, should be closely monitored throughout their treatment period. The South African TB control program should invest in patient adherence counselling and education to mitigate TB non-conversion risk factors, and to improve conversion and TB cure rates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1712-y) contains supplementary material, which is available to authorized users.
Highlights
Tuberculosis (TB) continues to be a major global health problem
In 2013, there were 410,000–520,000 cases of TB reported in South Africa, with more than 250,000 of these cases co-infected with human immunodeficiency virus (HIV) [2]
Description of the study cohort During 2007–2013, a total of 40,033 TB cases were registered in the Eden District ETR.Net database: 35,382 (88 %) pulmonary TB (PTB) cases only, 837 (2 %) PTB and extra-pulmonary TB (EPTB) cases and 3814 (10 %) EPTB cases only (Fig. 1)
Summary
Tuberculosis (TB) continues to be a major global health problem. While progress has been made to improve TB cure rates, South Africa’s 76 % smear-positive pulmonary TB (PTB) case cure rate remains below the WHO target of 85 %. We report on the trends of TB smear non-conversion and their predictors at the end of an intensive phase of treatment, and how this impacted on treatment outcomes of smear-positive PTB cases in Eden District, Western Cape Province, South Africa. Tuberculosis (TB) remains a major public health problem worldwide, with an estimated 9 million new cases and 1.5 million deaths reported in 2013 [1]. The latest estimates by the World Health Organization (WHO) TB Global Report indicates that the Asia and African regions accounted for more than two-third of new cases in 2013, with the highest absolute number of reported incident TB cases in India, China, Nigeria, Pakistan, Indonesia and South Africa [2]. While HIV has fuelled the incidence of TB in South Africa, the emergence of drug resistant TB is threatening to destabilize the already constrained South African National TB Control Program (NTCP) [6, 7]
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