Treatment Outcomes Among Notified Pulmonary Tuberculosis Cases in 67 Refugee Health Facilities in the Eastern Africa-IGAD Region: Historical Cohort, 2014-2017

Abstract

Background: Refugees are at increased risk for Tuberculosis (TB). In 2020, more than 3.9 million refugees were hosted in refugee camps/settlements in member countries of Intergovernmental Authority on Development (IGAD), East Africa. Regional evidence, therefore, on treatment outcome is important to improve the quality of TB care and strengthen the monitoring and evaluation system in the refugee settings. Objective: To assess trends of pooled TB treatment outcomes at the regional level and identify factors associated with unsuccessful treatment outcome among patients with pulmonary TB (PTB), bacteriologically confirmed pulmonary TB (BCPTB) and clinically diagnosed pulmonary TB (CDPTB) in refugee camps in IGAD region from 2014 to 2017. Methods: A retrospective cohort study was conducted in 67 refugee health facilities located in four countries (Ethiopia=25, Uganda=33, Kenya=5 and Sudan=4). Demographic and clinical data of all PTB patients registered between January 1, 2014 and December 31, 2017 were used. Descriptive analysis was done on the data and multivariate logistic regression analysis was used to identify baseline covariates associated with unsuccessful treatment. Results: A total of 4,072 TB cases (42%, 28%, 12% and 19% were from Kenya, Ethiopia, Sudan, and Uganda respectively) were included with more than half (62.4%) being BCPTB. 59.2% were males and 13.5% were HIV co-infected. The pooled treatment success rate (TSR) in the period under review was 80.7%. TSR was higher among the CDPTB compared to BCPTB cases in 2014 (86.5% vs. 81.3%), 2015 (87.5% vs. 84.8%) and 2016 (81.0 vs. 80.6%); but reversed in favour of BCPTB in 2017 (77.1% vs. 74.3%). Overall, 13.6% of the cases had unsuccessful treatment (treatment failed, died, or lost to follow-up). The factors significantly associated with unsuccessful treatment were positive HIV status (aOR 2.6[CI: 1.7 - 4.2]), male gender (aOR 1.7[CI: 1.4 - 3.8]), previous TB history (aOR 1.5[CI: 1.0 - 2.2]) and older age (aOR 1.7[CI: 1.1 - 2.8]). Conclusion: TB Treatment success rate in the refugee camps remained below the global target (≥ 90). TB-HIV co-infection, Male gender, previous history of treatment and age (15-34 &old age) increased the risk for unsuccessful treatment outcomes among PTB patients in the refugee camps.