Treatment Outcome Of TB Patients Research Articles

Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis

Background The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme. Methods This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results. Results In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56–0.83, p < .01 and HR 0.93, 95% CI 0.70–1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60–0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I 2 = 55.79%). Conclusions A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.

Outcome and determinants of Directly Observed Short-course treatment for tuberculosis patients

Background: The Directly Observed Treatment Short Course (DOTS) is a well-established and cost-effective strategy for treating Tuberculosis. It efficiently transforms infectious cases into non infectious ones, effectively interrupting the transmission cycle of the disease. Objectives: Measure the treatment outcomes in TB patients during 2016-2020, describe the socio-demographic and clinical profile of TB patients and evaluate the performance of the National TB program in Babil governorate based on WHO indicators. Methods: A descriptive cross-sectional study was done. All TB patients in the NTP Center of Babil governorate under the DOTS program from 2016 to 2020 were included. A form was developed to compile socio-demographic data, clinical presentation, and treatment outcomes. Results: A total number of cases was 1723. The mean age was 40.0 (± 21.0) years. The female constituted 53.8% of cases. The patients aged ≥ 65 years had the highest percentage of total cases 279 (16.2%). Pulmonary tuberculosis (PTB) constituted 56.1% of the cases 50.5% of them had smear-positive. The most common site for extrapulmonary tuberculosis (EPTB) was lymph nodes 41.1%. Treatment success was attained in 93.7%, while 3.3% of patients dead. The patients aged ≥ 65 years have the lowest success rate and highest treatment unsuccess rate opposite to young age groups (p 0.002). Conclusion: The treatment outcome target planned by WHO was achieved. The case detection rate of all form was low. The age and the site of TB significantly affected the outcome of treatment.

An Insight Into Tuberculosis Patients in the Chest Clinic of North India: Epidemiological Profile and Treatment Outcomes in the Wake of COVID-19.

Objectives Our study aims to re-evaluate the epidemiological profile and treatment outcomes of TB patients enrolled at the chest clinic of a tertiary care center after the third wave of COVID-19 in New Delhi. Patients and methods We have conducted an observational analytical study after taking the IEC approval from October 2022 to February 2022 on the TB patients enrolled from March 2022 to August 2022. The total data of 1114 TB patients was analyzed. The association between various factors and treatment outcomes was assessed using the chi-square test. To identify the independent effects of these factors on treatment outcomes, we did a multiple logistic regression analysis. Results We found that the treatment outcomes were mostly successful (83.9%, n=935), while a few patients lost to follow-up (11.7%, n=130) and died (4.4%, n=49). Deaths were significantly higher among geriatrics (19%, n=15), PTB (4.9%, n=30), and MDR TB (15%, n=3). The treatment success was highest among the new category of patients (85.1%, n=807), followed by retreatment patients (80.1%, n=117) and MDR TB patients (55%, n=11). Adults and geriatrics had a significantly higher risk of death (4.45 times and 27.93 times, respectively) compared to pediatrics. In addition, death risks were higher among males (1.6 times for females), MDR TB patients (17 times for new patients), and HIV-reactive patients (3.05 times for HIV non-reactive patients). Conclusion We found that males, HIV-TB co-infection, the geriatric population, pulmonary TB patients, and MDR TB were at a higher risk of death. By identifying high-risk groups, policymakers can prioritize targeted interventions and allocate resources effectively to address the specific needs of these vulnerable populations.

Effect of HIV status and antiretroviral treatment on treatment outcomes of tuberculosis patients in a rural primary healthcare clinic in South Africa.

Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV) infected individuals in South Africa. Despite the implementation of HIV/TB integration services at primary healthcare facility level, the effect of HIV on TB treatment outcomes has not been well investigated. To provide evidence base for TB treatment outcome improvement to meet End TB Strategy goal, we assessed the effect of HIV status on treatment outcomes of TB patients at a rural clinic in the Ugu Health District, South Africa. We reviewed medical records involving a cohort of 508 TB patients registered for treatment between 1 January 2013 and 31 December 2015 at rural public sector clinic in KwaZulu-Natal province, South Africa. Data were extracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. The effect of HIV status on TB treatment outcomes was determined by using multinomial logistic regression. Estimates used were relative risk ratio (RRR) at 95% confidence intervals (95%CI). A total of 506 patients were included in the analysis. Majority of the patients (88%) were new TB cases, 70% had pulmonary TB and 59% were co-infected with HIV. Most of HIV positive patients were on antiretroviral therapy (ART) (90% (n = 268)). About 82% had successful treatment outcome (cured 39.1% (n = 198) and completed treatment (42.9% (n = 217)), 7% (n = 39) died 0.6% (n = 3) failed treatment, 3.9% (n = 20) defaulted treatment and the rest (6.6% (n = 33)) were transferred out of the facility. Furthermore, HIV positive patients had a higher mortality rate (9.67%) than HIV negative patients (2.91%)". Using completed treatment as reference, HIV positive patients not on ART relative to negative patients were more likely to have unsuccessful outcomes [RRR, 5.41; 95%CI, 2.11-13.86]. When compared between HIV status, HIV positive TB patients were more likely to have unsuccessful treatment outcome in rural primary care. Antiretroviral treatment seems to have had no effect on the likelihood of TB treatment success in rural primary care. The TB mortality rate in HIV positive patients, on the other hand, was higher than in HIV negative patients emphasizing the need for enhanced integrated management of HIV/TB in rural South Africa through active screening of TB among HIV positive individuals and early access to ART among HIV positive TB cases.

Factors associated with poor treatment outcomes among tuberculosis patients in Kyangwali Refugee Settlement, Uganda, 2016-2017.

Communicable diseases, alone or in combination with malnutrition, account for most deaths in complex emergencies including refugee settings. Tuberculosis and HIV/AIDS are increasingly becoming an important cause of morbidity and mortality in refugee settings. We described the treatment outcomes of TB patients and explored factors associated with treatment outcomes among TB patients attending two facilities in Kyangwali Refugee Settlement in Kikuube District, 2016-2017. We abstracted data on laboratory-confirmed patient data from TB registers from 2016 to 2017, in Kikuube Health Centre IV and Rwenyawawa Health Centre II, both located in Kyangwali Refugee Settlement. We abstracted data on socio-demographic variables including age and sex. Other variables were height, weight, final treatment outcomes, demographics, HIV status, TB treatment category, and history of TB. Treatment outcomes were categorized into favorable (including patients who were cured or those who completed treatment) and unfavorable (those in whom treatment failed, those who died, those lost to follow-up, or those not evaluated). We used logistic regression to identify factors associated with unfavorable treatment outcomes. We identified a total of 254 TB patients with a median age of 36 (IQR 26-48) years; 69% (175) were male and 54% (137) were refugees. The median weight was 50.4 kg (range 4-198). Overall, 139 (55%) had favorable outcomes while 115 (45%) had unfavorable outcomes. Refugees formed 53% (71) of those with favorable outcomes and 47% (63) of those with unfavorable outcomes 63(47%). We found that increasing age was statistically associated with unfavorable outcomes, while diagnosis with MDR-TB was associated with decreased odds for unfavorable treatment outcomes. The treatment success rate was lower compared to 85% recommended by WHO. However, the rates are similar to that reported by other studies in Uganda. Innovative approaches to improve treatment success rates with particular focus on persons aged 41-80 years should be devised.

Negative Regulator Nlrc3-like Maintain the Balanced Innate Immune Response During Mycobacterial Infection in Zebrafish

The NOD-like receptors (NLRs) have been shown to be involved in infection and autoinflammatory disease. Previously, we identified a zebrafish NLR, nlrc3-like, required for macrophage homeostasis in the brain under physiological conditions. Here, we found that a deficiency of nlrc3-like leads to decreased bacterial burden at a very early stage of Mycobacterium marinum infection, along with increased production of pro-inflammatory cytokines, such as il-1β and tnf-α. Interestingly, myeloid-lineage specific overexpression of nlrc3-like achieved the opposite effects, suggesting that the impact of nlrc3-like on the host anti-mycobacterial response is mainly due to its expression in the innate immune system. Fluorescence-activated cell sorting (FACS) and subsequent gene expression analysis demonstrated that inflammasome activation-related genes were upregulated in the infected macrophages of nlrc3-like deficient embryos. By disrupting asc, encoding apoptosis-associated speck-like protein containing a CARD, a key component for inflammasome activation, the bacterial burden increased in asc and nlrc3-like double deficient embryos compared with nlrc3-like single deficient embryos, implying the involvement of inflammasome activation in infection control. We also found extensive neutrophil infiltration in the nlrc3-like deficient larvae during infection, which was associated with comparable bacterial burden but increased tissue damage and death at a later stage that could be alleviated by administration of dexamethasone. Our findings uncovered an important role of nlrc3-like in the negative regulation of macrophage inflammasome activation and neutrophil infiltration during mycobacterial infection. This highlights the importance of a balanced innate immune response during mycobacterial infection and provides a potential molecular basis to explain how anti-inflammatory drugs can improve treatment outcomes in TB patients whose infection is accompanied by a hyperinflammatory response.

Re-evaluated treatment outcomes of bacteriologically positive TB patients registered at a clinic in Lusaka, Zambia in 2018.

An urban TB diagnostic centre in Lusaka, Zambia. To re-evaluate treatment outcomes of all bacteriologically confirmed TB patients registered in 2018. This was a retrospective cohort study on TB patients. Treatment outcomes of patients who were transferred out were retrieved. A total of 182 patients were registered, 26 of whom had missing documents; these were excluded from the study. Of the remaining 156 patients who were reviewed, 86 (55.1%) were correctly evaluated by the centre, 35 (22.4%) were incorrectly evaluated and 35 (22.4%) were 'transferred out' (not evaluated). As a result of this review, the number of evaluated patients increased from 86 (55.1%) to 150 (96.2%). The cure and treatment success rates rose from 43.6% and 44.2%, respectively, to 57.7% and 73.1%, respectively. Of note, 14 of the 35 patients who were initially declared 'transferred out' did not actually reach their treatment facilities and ended up being lost to follow-up. This study shows that it is possible to evaluate almost all TB patients. Re-evaluation of treatment outcomes of TB patients revealed the problems in the TB services that need to be improved in the future.

Should treatment of low-level rifampicin mono-resistant tuberculosis be different?

BackgroundRifampicin resistant tuberculosis (RR-TB) was frequently detected in Suriname after the introduction of Xpert MTB/RIF in 2012. Subsequent phenotypic drug-susceptibility testing (DST) was not conclusive at that moment, while RR-TB patients treated with first-line tuberculostatics had good treatment outcome. In our study, we analysed this interesting observation. MethodsWe collected demographic and clinical characteristics and treatment outcome of TB patients from May 2012-December 2018 and performed a univariate and multivariate analysis to assess possible associations with resistance to rifampicin. Secondly, we conducted whole genome sequencing on all available Mycobacterium tuberculosis isolates that had a rifampicin resistance in the Xpert MTB/RIF test and performed phenotypic DST on selected isolates. FindingsRR-TB was detected in 59 (9.6%) patients confirmed by Xpert. These patients were treated with rifampicin-containing regimens in most (88%) of the cases. In all 32 samples examined, a D435Y mutation in the rpoB gene was identified; only one isolate revealed an additional isoniazid mutation. Phenotypic DST indicated low-level rifampicin resistance. In multivariate analysis, the Creole ethnicity was a factor associated with rifampicin resistance (aOR 3.5; 95%CI 1.9–6.4). The treatment success rate for patients with RR-TB (78.0%) was comparable to the treatment outcome in non-RR-TB patients 77.8%. InterpretationThis study confirms a low-level rifampicin mono-resistance in TB patients of Suriname. These patients could benefit from a first-line regimen with high dose rifampicin (or rifabutin), rather than from the lengthy treatment regimens for rifampicin-resistant and multi-drug resistant TB, a concept of stratified medicine also advocated for the treatment of TB. FundingNone.

1342. Impact of HIV Infection on Treatment Outcome of New Tuberculosis Patients Attending Tuberculosis and Antiretroviral Treatment Services in the Community-Based Hospital, Thailand: A Retrospective Cohort Study

BackgroundTuberculosis (TB) and HIV are one of the significant public health problems in Thailand, and an estimated 15,000 individuals have a dual infection. Both HIV and TB each disease speeds up the progression of each other. TB is the leading cause of death in HIV-infected individuals, and HIV coinfected TB patients have disease-specific, and treatment affected their treatment outcomes. There is insufficient evidence on issues of TB and HIV co-infection patients received treatment. This study aimed to assess the impact of HIV status on treatment outcome of TB patients.MethodsWe conducted a retrospective cohort study among TB patients who registered to service at Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand from October 1, 2017 to October 31, 2018. All patients’ demographic data, diagnosis, and treatment were retrieved. Clinical characteristics, treatment outcome, and factors associated with treatment outcome were analyzed.ResultsThere were 49 (10.65%) HIV among 460 TB patients with a median (IQR) age of 44 (32–61) years old and 65.2% were males. Disseminated TB and extrapulmonary TB were higher in HIV coinfected group (P < 0.001). All pulmonary TB patients’ lower lobe involvement was higher in HIV coinfected group (62.50 vs. 36.00, P = 0.001). In HIV coinfected group median CD4 was 134 cell/mm3 (IQR 19–294), 66.67% were diagnosed HIV infection after TB diagnosis, the median time from TB diagnosed to antiretroviral was 29 days (IQR 21–48). The overall treatment success rate was 93.04%; the treatment success rate was similar in HIV coinfected TB patients (89.80%) and non- HIV-infected patients (93.43%) (P = 0.66).Adverse drug reactions were higher in HIV coinfected group (44.89% vs 12.41%) (P < 0.001). By multiple stepwise logistic regression, factors associated with anti-TB drug adverse reactions were having HIV infection (OR 7.99; 95% CI 3.73–17.10, P < 0.001), Age >60 years (OR 2.64; 95% CI 1.43–4.87, P = 0.002) and female sex (OR 1.97; 95% CI 1.11–3.52, P = 0.02).ConclusionThere is a high TB treatment success rate among patients who have treated for TB, but adverse drug events in HIV co-infected TB patients is higher than that observed in non-HIV-infected patients. Disclosures All authors: No reported disclosures.

Incidence of adverse reactions caused by first-line anti-tuberculosis drugs and treatment outcome of pulmonary tuberculosis patients in Morocco.

The treatment of tuberculosis is associated with a high incidence of adverse reactions with different degrees of severity. The aim of this study was to determine the incidence of adverse reactions caused by first-line anti-tuberculosis drugs and to evaluate the treatment outcome of TB patients in a large region of Morocco. It is a multi-centric observational cohort study conducted from January 01, 2014 to January 01, 2016. A questionnaire was established for data collection from clinical charts of TB patients. The study was carried out in all the 18 centers located in the Rabat-Salé-Kénitra region of Morocco where tuberculosis is treated. Adverse reactions are evaluated from the start of TB treatment until its end by a specialist clinician. The treatment outcomes are evaluated, and the definitions and classifications of these outcomes are defined according to World Health Organization guidelines. Among a total number of 2532 patients treated for TB, the average age is 37.3 ± 16.4years, 10.0% of patients produced adverse reactions.7.4% of adverse reactions are gastrointestinal, 3.7% are cutaneous, 2.0% are hepatic, 1.14% are articular, 1.07% are immunoallergic, 0.7% are neuropsychiatric, and 0.1% are ocular. The treatment outcome of TB patients is 79.1% rate for successful treatment and 15.6% for unsuccessful treatment. Adverse reactions caused by anti-TB drugs are frequent among patients with TB. These ADRs must be followed up by a closer monitoring during anti-TB treatment period. Treatment success outcome in our study is slightly lower than the success rate target of WHO of at least 85%.

Factors associated with unsuccessful treatment outcome in tuberculosis patients among refugees and their surrounding communities in Gambella Regional State, Ethiopia.

BackgroundTuberculosis (TB) is a leading cause of public health challenges among immigrant refugees and their surrounding communities in developing countries. Evaluating the treatment outcome of TB patients is one of the key indicators to understand the performance of TB control program. Hence, this study aims to assess profile, treatment outcome and factors associated with unsuccessful outcome of TB patients treated under the TB control program among refugees and their surrounding communities (SCs) in Gambella Regional State, Ethiopia.MethodologyRetrospective study was conducted in the health facilities of refugee and their SCs in Gambella Regional State from March 1 to May 30, 2017. Demographic and related data of all TB patients registered in TB Control Program between September, 2008 and October, 2017 in health facilities of refugee and the SCs was extracted using data extraction format. Eight years trend of TB, treatment outcome and factors associated with unsuccessful outcome among refugees and the SCs were computed using SPSS version 20.0 software.ResultA total of 886 refugees and 3284 SCs TB patients, registered for anti TB treatment in the last eight years, were evaluated in the study. The trend of all forms of TB is progressively increasing among refugees contrary to the SCs in the course of the study period (X2 trend = 207.7; P<0.0001). Smear positive pulmonary TB (PTB+) was found to be predominant (57.6%) TB form in refugees while smear negative pulmonary TB (PTB-) (44.8%) is in the SCs (X2 = 185.834; P<0.0001). There was also significant difference in the treatment outcome (X2 = 170.915; P<0.0001). Mean treatment success rate was 74.2% and 88.1% for refugees and the SCs, respectively (X2 = 92.887; P<0.0001). The study also revealed that the risk of unsuccessful TB treatment outcome was significantly higher among refugee (AOR = 2.17; 95% CI: 1.69–2.77), retreated cases (AOR = 1.53; 95% CI: 1.07–2.17), patients aged between 35–44 years (AOR = 1.38; 95% CI: 1.0–1.91), and greater than 44 years old (AOR = 1.77; 95% CI: 1.28–2.44), and patients with extra pulmonary TB (EPTB) form (AOR = 1.34; 95% CI: 1.04–1.73) compared to their counterparts. Patient coming from rural area (AOR = 0.77; 95% CI: 0.62–0.97), who are female (AOR = 0.76; 95% CI: 0.63–0.91) and TB/HIV non-infected (AOR = 0.63; 95% CI: 0.51–0.77) were more likely to be successfully treated.ConclusionThe study confirmed that there was low treatment success rate among refugees compared to the SCs. Being refugee, retreated case, patient’s age ≥35 years old, EPTB form, gender, rural patient address and HIV status were predictor factors for unsuccessful treatment outcome. Hence, the study urges the need for strengthened TB prevention program among refugees with due consideration of identified predictor factors to prevent the potential effect of hosting refugee to the SCs and the nations at large.

Urine IP-10 as a biomarker of therapeutic response in patients with active pulmonary tuberculosis

BackgroundPrior to clinical trials of new TB drugs or therapeutic vaccines, it is necessary to develop monitoring tools to predict treatment outcomes in TB patients. Urine interferon gamma inducible protein 10 (IP-10) is a potential biomarker of treatment response in chronic hepatitis C virus infection and lung diseases, including tuberculosis. In this study, we assessed IP-10 levels in urine samples from patients with active TB at diagnosis, during treatment, and at completion, and compared these with levels in serum samples collected in parallel from matched patients to determine whether urine IP-10 can be used to monitor treatment response in patients with active TB.MethodsIP-10 was measured using enzyme-linked immunosorbent assays in urine and serum samples collected concomitantly from 23 patients with active TB and 21 healthy adults (44 total individuals). The Mann-Whitney U test and Wilcoxon matched-pairs signed rank test were used for comparisons among healthy controls and patients at three time points, and LOESS regression was used for longitudinal data.ResultsThe levels of IP-10 in urine increased significantly after 2 months of treatment (P = 0.0163), but decreased by the completion of treatment (P = 0.0035). Serum IP-10 levels exhibited a similar trend, but did not increase significantly after 2 months of treatment in patients with active TB.ConclusionsUnstimulated IP-10 in urine can be used as a biomarker to monitor treatment response in patients with active pulmonary TB.

Factors Affecting Treatment Outcome of Tuberculosis among Tuberculosis Patients in West Ethiopia

Background: Tuberculosis is a life threatening disease caused by mycobacterium tuberculosis. In developing countries the incidence of tuberculosis has been increasing steadily since the 1990s, particularly in African countries. Several European countries have lately reported a slight increase in tuberculosis, but these are mostly related to immigrants from high-incidence countries.Objective: To assess the treatment outcomes of tuberculosis and its associated factors among tuberculosis patients on anti-tuberculosis therapy in Nekemte Referral Hospital, West Ethiopia.Methods: A four years retrospective cross-sectional study was used and all patients’ information that fulfilled the inclusion criteria was retrieved from records of patients with basic information for all registered patients. We analyzed the records of 315 tuberculosis patients who had known outcome in Nekemte Referral Hospital from September 2012-August 2016.Results: From the total of 315 patients who had known treatment out come in Nekemte Referral Hospital, tuberculosis type was categorized as smear positive pulmonary TB in 68(21.5%), smear negative pulmonary TB in 107(34.0%), and extra pulmonary in 140(44.4%) cases. Records of the 315 TB patients showed that 54(17.01%) were cured, 206(65.4%) completed treatment, 24(3.5%) had treatment failure, 11(3.5%) defaulted, 20(6.3%) were died. The overall treatment success rate of the TB patients was 82.5%. Age ≥ 45 years (AOR=7.1, 95% CI=1.5-34.3, p=0.014), smear negative PTB (AOR=3.4, 95%, CI=1.5-9.5, P=0.023) and retreatment cases (AOR=12.0, 95%, CI=4.2-34.4, P<0.001) were significantly associated with unsuccessful treatment outcome.Conclusion: Successful treatment outcome of TB patients was below standard. To improve treatment outcome among TB patients health education on the importance of TB treatment and the consequences of poorly treated TB have to be provided to patients during their follow up.

Reviewing treatment outcomes of tuberculosis patients at Zagazig Chest Hospital (2008–2012)

BackgroundTuberculosis (TB) is one of major critical heath problem worldwide, where drug treatment is fundamental for controlling TB promoting cure of the patient and breaking the chain of transmission when treatment is completely and correctly followed. Aim of the studyAim of the study is to assess the treatment outcomes of TB patients at Zagazig Chest Hospital and to identify factors associated with poor outcomes in a trial to achieve the national tuberculosis program (NTP) goals. Patients and methodsThis is a cohort study that was carried out at Zagazig Chest Hospital which was in part retrospective and prospective in other part. Analysis of data of 290 tuberculous patients was done where 10 cases were excluded. Demographic, socioeconomic data were reported in addition to radiological, bacteriologic histopathological diagnostic data and history of previous treatment of TB and the used anti-tuberculous treatment regimens with application of directly observed therapy short course (DOTS) strategy. Treatment outcomes were assessed for all patients and were classified either as successful or unsuccessful. ResultsSuccessful treatment outcome was reported in 231 (82.5%) TB cases versus 49 (17.5%) cases with unsuccessful treatment. Successful outcome was significantly associated with middle age (16–35 years) (51.5%) (P < .05), well education (78.8%) (P < .001), absence of history of contact with positive TB case (96.1%) (P < .001), mild to moderate advanced X-ray picture (95.5%) (P < .001) and absence of previous history of anti-tuberculous treatment (87.1%) (P < .01). Multivariate logistic regression analysis for risk factors for unsuccessful outcome revealed that illiteracy (P < .001), history of contact to positive TB cases (P < .001) and far advanced chest X-ray of pulmonary TB (P < .001) were considered as significant predictors. ConclusionsA high rate of successful treatment is reported with application of the NTP (2012) guidelines which was associated with middle age of the patients (16–35 years), well education, mild to moderate advanced X-ray picture and absence of either history of contact with positive TB case or previous history of anti-tuberculous treatment(new case). Illiteracy, history of contact to positive TB cases, far advanced chest X-ray of pulmonary TB and previously treated cases on CAT II regimen could be considered as predictors of unsuccessful outcome.

Treatment outcome of tuberculosis patients treated under DOTS in Calicut

Background: Tuberculosis remains a worldwide public health problem despite the fact that highly effective drugs are available making TB a curable disease. DOTS chemotherapy remains central to the public health approach to tuberculosis control under RNTCP. The present study is conducted to know the clinical profile and treatment outcome of TB patients registered under RNTCP in Mukkam CHC, Calicut. The study was conducted with the following objectives: 1) to study the treatment outcome of TB patients receiving DOTS, 2) to find the occurrence of pulmonary, extra-pulmonary and MDR TB and 3) to find out factors responsible for poor treatment outcome.Methods: This record based study was conducted in Mukkam CHC. Details of patients who were enrolled under RNTCP in the year 2013 were collected from RNTCP records. Data was analyzed using SPSS version 16. Results are expressed in percentage. Statistical analysis used was Chi square test.Results: Out of 289 patients studied, 66.78% were males and 33.22% were females. 69.5% of the patients were having pulmonary TB and 30.5% extrapulmonary TB. There were two cases of MDR TB. 58% of the patients with pulmonary TB were sputum positive and 42% were sputum negative. 87.8% were given Cat I treatment and 11.7% were given Cat II treatment. Only one patient was on Non DOTS regimen. 96.6% of the patients had completed DOTS. When treatment outcome was analyzed, the patients with treatment completed was 54%, cured 35%, defaults 4%, treatment failure 2% and transfer out 2% and 3% of patients died during the course of the treatment. 7.61% of patients had diabetes mellitus and only one case was reported HIV positive. Treatment outcome was significantly associated with type of patient and pulmonary TB sputum positivity.Conclusions:The treatment success rate was 100% in 0-5 years and least in &gt; 65years of age group. Further studies are required to find out the reasons for comparatively high proportion of sputum smear negative cases.

Treatment outcomes among tuberculosis patients at an urban health centre, Goa, India- eight year retrospective record based study

Background: India contributes the highest TB burden globally and DOTS being the key strategy of RNTCP needs evaluation. The objective of this study was to assess treatment outcomes in TB patients on DOTS in terms of success rates in new and retreatment cases.Methods: Retrospective record based study was conducted at urban health centre, Santa Cruz Goa, India including 135 TB cases registered from January 2008 to January 2016 for DOTS. Data on treatment outcomes was analysed using appropriate statistical methods and percentages were calculated.Results: Out of total 135 TB cases, 64.4% had pulmonary while 35.6% had extra-pulmonary TB. Percentage of new cases was 84.4% whereas 15.6% were retreatment cases. Success rate (cure rate plus treatment completion rate) for new cases was 84.2% and for retreatment cases was 76.2% while the overall success rate was 83%.Conclusions: Successful treatment outcome was lower compared to the RNTCP norm.

Profile of tuberculosis and its response to anti-TB drugs among tuberculosis patients treated under the TB control programme at Felege-Hiwot Referral Hospital, Ethiopia.

BackgroundTuberculosis (TB) is a global concern for both developing and developed countries. Currently it becomes more complex due to increasing levels of drug resistance and HIV co-infection. Delayed diagnosis and high case load are major factors contributing to continued transmission and failure to the treatment outcome. The study was conducted to determine the profile and treatment outcomes of TB patients at Felege-Hiwot Referral Hospital.MethodsWe analyzed the records of 1761 TB patients registered for treatment in Felege Hiwot Referral Hospital from July 2010 to June 2015. Data on patients’ socio-demographic characteristics, type of TB, HIV status and treatment outcome were analysed. Descriptive statistics and binary logistic regression models were used to present data. The odds ratio and the 95 % confidence intervals were calculated. A p-value of < 0.05 was considered statistical significant.ResultsThe proportion of smear positive, smear-negative and extra-pulmonary TB were 205 (11.6 %), 548 (31.1 %) and 1008 (57.2 %), respectively. The overall treatment success rate accounts 542(80.8 %) with unsuccessful treatment of 129(19.2 %). The treatment outcome varied by the years from 68.9 to 97.4 %. Among tuberculosis patients, 459(26.1 %) of them were HIV positive. Being HIV positive (AOR = 4.29, 95 % CI, 2.20–8.37 P = 0.001), retreatment (AOR = 5.32, 95 % CI, 1.92–14.3, P = 0.001), rural residency (AOR = 18.0, 95 % CI, 9.06–37.82, P = 0.001) and the age group of 15–24 years (AOR = 2.91, 95%CI, 1.00–8.45, P = 0.04) showed statistical significant association for poor treatment outcome.ConclusionsIn the studied region, the overall treatment success rate was still below the WHO target of success rate, 85 %. However, the trend of treatment success rate showed a promising increment. Patients at high risk of unsuccessful treatment outcome should be identified early and given additional follow-up, medical intervention and social support.

Treatment Outcome of Tuberculosis Patients and Associated Risk Factors at Dessie and Woldiya Town Health Institutions, Northeast Ethiopia: A Retrospective Cross Sectional Study

Background: Ethiopia introduced directly observed therapy short-course (DOTS) strategy for TB in 1995; reaching its full coverage in 2005. Treatment success rate (TSR) was 84% in 2009 and dropped to 83% in 2010. Despite the progress made in tuberculosis control throughout Ethiopia, risk factors leading to poor treatment outcome have not been assessed in Dessie and Woldiya town health institutions. Therefore, this study aimed to determine treatment outcome of TB patients and risk factors for poor treatment outcome in Dessie and Woldiya town health institutions, Northeast Ethiopia. Methods: A three years (September 2010 to August 2012) retrospective study was conducted from medical records of 1511 TB patients at Dessie and Woldiya town health institutions. Data were collected using a questionnaire that consists of patients’ age, sex, weight, TB history, TB type, HIV status, availability of supporter, availability of mobile number, drug type and TB treatment outcomes in treatment cards and TB logbook from February, 2013 to April, 2013. Pearson chi-square test and logistic regression were employed for data analysis. Results: From 1511 TB patients, 1,331(88.1%) were successfully treated, 123 (8.1%) died, 45 (3.0%) defaulted and 12 (0.8%) failed from treatment. In terms of TB type, 57.4% were pulmonary TB, 40.5% were extra pulmonary TB and 2.1% were both smear negative pulmonary and extra pulmonary TB. In addition, TB-HIV co-infection rate was 42.9% in 2010, with significant reduction in 2012 (33.7%) (P<0.01). Multivariate logistic regression showed the odds of successful treatment outcome was higher among females (AOR=2.09, 95% CI: 1.27-3.45), new TB patients (AOR=10.52, 95% CI: 3.96-27.93), patients with unknown HIV status (AOR=7.16, 95% CI; 1.56-32.75) and HIV negative (AOR=1.80, 95% CI: 1.09-2.99) when compared with the respective comparison groups. The odds of defaulting was higher among TB patients started treatment in Dessie Health Center (AOR=4.09, 95% CI: 1.33-12.60) and combined smear negative pulmonary and extra pulmonary TB disease (AOR=8.87, 95% CI: 2.53-31.02) compared with the respective comparison groups. Conclusions: Treatment success rate of TB patients in this study was very encouraging for TB control through DOTS strategy. Nevertheless, TB patients with HIV/AIDS, combined smear negative pulmonary and extra pulmonary TB and with previous history of TB were found to be at risk of poor treatment outcome. Correspondingly, male TB patients and those who attend health centers should be encouraged for successful treatment outcome. Generally, to reduce poor treatment outcome, patients should be strictly followed by health extension workers or trained community health workers in Dessie and Woldiya town health institutions.

High prevalence of multidrug-resistant tuberculosis in Zunyi, Guizhou Province of China

Sir, According to the WHO Report 2010, China had the most multidrug-resistant tuberculosis (MDR-TB) cases in 2008, followed by India and Russia, and was ranked 16th in terms of the estimated proportion of primary (5.7%) and acquired (previously treated) MDR-TB cases among the 27 MDR-TB highburden countries. However, our recent drug-susceptibility surveillance results indicated that the prevalence of acquired MDR-TB cases in the Zunyi area, Guizhou province, China, was much higher (45.1%) than the average prevalence of acquired MDR-TB in China (25.6%), but lower than those in the top six MDR-TB high-burden countries (Tajikistan, Kazakhstan, Azerbaijan, Republic of Moldova, Uzbekistan and Lithuania). To determine the prevalence and trends of drug-resistant TB in the Zunyi area, in order to improve the treatment outcomes of TB patients, 263 Mycobacterium tuberculosis clinical isolates were collected at the Affiliated Hospital of Zunyi Medical College from 2008 to 2010 and used in drug susceptibility testing against rifampicin, isoniazid, streptomycin and ethambutol. We used the proportion method on Lowenstein–Jensen media with different concentrations of drugs (rifampicin 40 mg/L, isoniazid 0.2 mg/L, streptomycin 4 mg/L and ethambutol 2 mg/L). The standard M. tuberculosis H37Rv strain was used as a control for all testing. To compare our results with those from other provinces of China, we selected recent survey results from Shanghai and 4 out of the 10 provinces (covering 38% of the total Chinese population) with the highest rates of MDR among new TB cases (5.4%–10.4%), and combined them with ours in Table 1. Results indicated that the Zunyi area had the highest prevalence of MDR-TB among previously treated (45.1%) and the second highest among new (8.1%) TB cases in China. In addition, it was observed that the proportions of rifampicin and isoniazid resistance in previously treated (56.0% versus 59.3%) and new (12.2% versus 14.5%) TB cases from the Zunyi area were similar (Table 1), which indicated that isoniazid resistance might be related to rifampicin resistance and that screening for rifampicin resistance could be used as a marker for the detection of MDR-TB. Since isoniazid has not been widely used as monotherapy for latent TB in China, this could explain the relative lack of single resistance to isoniazid in new TB cases observed in this study. It is obvious that percentages of TB cases with resistance to any of the four drugs in the Zunyi area were much higher than those from other provinces among previously treated TB cases (Table 1), suggesting that the Zunyi area of Guizhou province is one of the worst-affected areas in China and should be included in future surveillance of drug resistance in tuberculosis to better represent the prevalence of MDR-TB in China. To compare our results with those from other high-burden countries, such as India and Russia, we selectively included in Table 1 four studies with the highest proportions of MDR among previously treated patients (from 49% in Haryana to 38.2% in Rajasthan) out of the eight studies from India, five countries with the highest proportions of MDR among new TB cases (from 14.4% in Latvia to 4.0% in Ivanovo Oblast) from 35 countries that participated in the global surveillance (1994–97), and five countries with the highest proportions of MDR among new TB cases (from 22.3% in Azerbaijan to 14.8% in Uzbekistan) out of 83 countries/territories surveyed between 2002 and 2007. Comparison of the results shows that the Zunyi area of Guizhou Province, China, has the highest rate of TB cases resistant to ethambutol among previously treated patients (41.8%), and is one of the top 10 areas in the world in terms of the estimated proportion of MDR-TB cases among previously treated TB cases. Consequently, more surveillance should be conducted in the Zunyi area to monitor the trend of MDR-TB transmission, improve the treatment outcomes of TB patients and control the spread of drug-resistant TB, especially MDR-TB.