Tuberculosis Treatment Success Rate Research Articles

Prevalence of tuberculosis-HIV co-infection and factors associated with treatment outcome among the tuberculosis patients in HIV treatment facility in a teaching hospital in Jos, North Central Nigeria

Background: Globally, tuberculosis (TB) remains a disease of grave public health concern. It ranks above HIV/AIDS as the leading cause of death from a single infectious agent, and as one of the 10 most common causes of mortality. This study assessed the prevalence of TB-HIV co-infection and factors associated with treatment outcome among the TB patients in an HIV treatment facility in a Teaching hospital in Jos, North central Nigeria. Methods: A 10-year retrospective, descriptive cross-sectional review was conducted and data was extracted through the review of TB registers. Data were analysed using SPSS version 20 and bivariate analyses was conducted at P < 0.05. Results: The prevalence of TB-HIV co-infection was 9.25%, with the mean age of the study participants being 41.8 ± 11.6 years. Of all the participants, 87.5% had successful treatment outcome, while 12.5% had unsuccessful treatment outcome. In the bivariate analysis, place of residence was the only socio-demographic factor significantly associated with treatment outcome (<0.001). Conclusion: The TB-HIV co-infection prevalence rate was about 10% of the total HIV population with a high TB treatment success rate. With the exception of place of residence, no other factor had statistically significant relationship with the treatment outcome.

Tuberculosis treatment outcomes and associated factors in two states in Nigeria

To determine the treatment success rate among TB patients and associated factors in Anambra and Oyo, the two states with the largest burden of tuberculosis in Nigeria. A health facility record review for 2016 was conducted in the two states (Anambra and Oyo). A checklist was used to extract relevant information from the records kept in each of the selected DOTS facilities to determine TB treatment success rates. Treatment success rate was defined as the proportion of new smear-positive TB cases registered under DOTS in a given year that successfully completed treatment, whether with bacteriologic evidence of success ('cured') or without ('treatment completed'). Treatment success rate was classified into good (≥85%) and poor (<85%) success rates using the 85% national target for TB treatment outcome. Data were analysed using descriptive statistics and chi-square at P<0.05. There were 1281TB treatment enrollees in 2016 in Anambra and 3809 in Oyo (total=4835). An overall treatment success rate of 75.8% was achieved (Anambra-57.5%; Oyo-82.0%). The percentage cure rates were 61.5% for Anambra and 85.2% for Oyo. Overall, only 28.6% of the facilities in both states (Anambra-0.0%; Oyo-60.0%) had a good treatment success rate. More facilities in Anambra (100.0%) than Oyo (40.0%) had a poor treatment success rate (p<0.001), as did more private/FBO (100.0%) than public health facilities (60.0%) (p=0.009). All tertiary facilities had a poor treatment success rate followed by 87.5% of secondary health facilities and 56.5% of primary healthcare facilities (P=0.035). Treatment success and cure rates in Anambra state were below the 85.0% of the recommended target set by the WHO. Geographical location, and level/tier and type of facility were factors associated with this. Interventions are recommended to address these problems.

Tuberculosis Case Finding Cascade and Treatment Outcomes among Male Inmates in Two Prisons in Zimbabwe.

Design A cohort study using programmatic data was undertaken to assess TB diagnostic cascade in one of the study prisons for 2018. Treatment outcomes among male inmates with TB were assessed over a period of four years, in two study prisons. Results A total of 405 (11%) inmates with presumptive TB were identified, and 370 (91%) of these were evaluated for TB, mostly using rapid molecular testing of sputum specimens. Twenty-five inmates were diagnosed with TB resulting in a prevalence of 649/100,000 population. Of these, 16 (64%) were started on treatment. Nine (36%) were lost to follow-up before treatment initiation. From 2015 to 2018, 280 adult male inmates with TB were started on treatment. Of these, 212 (76%) had pulmonary disease that was bacteriologically confirmed. Almost all (276/280, 99%) had known HIV status, 65% were HIV-infected, and 80% of these were on antiretroviral treatment. The TB treatment success rate (cured or treatment completed) was recorded for 209 (75%) inmates, whilst 14 (5%) died and 11 (4%) were lost to follow-up. The frequency of unfavourable treatment outcomes (death, lost to follow-up, and not evaluated) was higher (54%) among inmates ≥ 60 years than those in the age group of 45-59 years (17%). Conclusion The findings revealed a threefold burden of TB in prisons, compared with what is reported by national survey. To decrease transmission of TB bacilli, it is essential to promote efforts that address missed opportunities in the TB diagnostic cascade, prompt treatment initiation, and ensure that tracking and documentation of treatment outcomes for all inmates are intensified.

Assessing the efficiency of Iran health system in making progress towards universal health coverage: a comparative panel data analysis

BackgroundBuilding upon decades of continuous reforms, Iran has been implementing various initiatives to reach universal health coverage (UHC). Improving efficiency is a crucial intermediate policy objective for UHC. Therefore, this article aimed to measure the efficiency and productivity changes of the Iranian health system in making progress towards UHC during 2010−2015 in comparison with 36 selected other upper-middle-income countries.MethodsWe used panel data to measure the variations in technical efficiency (TE) and total factor productivity (TFP) through an extended data envelopment analysis (EDEA) and Malmquist productivity index, respectively. General government health expenditure (GGHE) per capita (International dollar) was selected as the input variable. Service coverage of diphtheria, tetanus and pertussis; family planning; antiretroviral therapy; skilled attendants at birth; Tuberculosis treatment success rate; and GGHE as % of total health expenditure (THE) were considered as output variables. The data for each indicator were taken from the Global Health Observatory data repository and World Development Indicator database, for 6 years (2010−2015).ResultsThe TE scores of Iran’s health system were 0.75, 0.77, 0.74, 0.74, 0.97, and 0.84 in the period 2010–2015, respectively. TFP improved in 2011 (1.02), 2013 (1.01), and 2014 (1.30, generally). The overall efficiency and TFP increased in 2014. Changes made in CCHE per capita and GGHE/THE attributed to the increase of efficiency.ConclusionThere is a growing demand for efficiency improvements in the health systems to achieve UHC. While there are no defined set of indicators or precise methods to measure health system efficiency, EDEA helped us to draw the picture of health system efficiency in Iran. Our findings highlighted the essential need for targeted and sustained interventions, i.e., allocation of enough proportion of public funds to the health sector, to improve universal financial coverage against health costs aiming to enhance the future performance of Iran’s health system, ultimately. Such tailored interventions may also be useful for settings with similar context to speed up their movement towards improving efficiency, which in turn might lead to more resources to reach UHC.

The Factors associated with the unsuccessful tuberculosis treatment of hill tribe patients in Thailand

Tuberculosis (TB) remains a serious public-health problem worldwide. The successful tuberculosis treatment was in low rate among the hill tribes in Thailand. This study aimed to determine factors associated with the unsuccessful tuberculosis treatment among the hill tribe TB patients in northern Thailand. A retrospective cohort study was conducted using secondary data from the national TB reporting system. Data of newly registered hill tribe patients with TB receiving treatment were obtained from 18 government hospitals in Chiang Rai province, during 2014-2017. TB treatment outcomes and factors associated with unsuccessful were determined. A total of 770 hill tribe patients with TB registered during the study period. The majority were males aged 25-64 years. About 80% of the patients lived in rural areas and 53.9% worked in agriculture. The overall TB treatment success rate was 80.4%. Two factors were associated with unsuccessful TB treatment: ages 25-44 and ages 45-64 (aOR 3.14 (1.03-9.55) and 3.02 (1.01-9.03), respectively) and receiving antiretroviral drugs (proxy of HIV infection) (aOR 2.30 (1.02-5.15)). Although the TB treatment success rate among hill tribe patients did not reach the national goal, it was still higher than that of other Thai TB patients in the area. In Thailand, hill tribe people can access health services free-of-charge under the national health insurance. This could influence the successful treatment. However, some barriers need to be considered, such as the high default rate and high death rate among those with HIV coinfection.

Does phone messaging improves tuberculosis treatment success? A systematic review and meta-analysis

BackgroundCompliance to anti-TB treatment is crucial in achieving cure and avoiding the emergence of drug resistance. Electronic health (eHealth) interventions are included in the strategy to end the global Tuberculosis (TB) epidemic by 2035. Evidences showed that mobile messaging systems could improve patient adherence to clinic appointment for diagnosis and treatment. This review aimed to assess the effect of mobile-phone messaging on anti-TB treatment success.MethodsAll randomized controlled trial (RCT) and quasi-experimental studies done prior to August 26, 2019 were included in the review. Studies were retrieved from PubMed, EMBASE, Cochrane and ScienceDirect databases including, grey and non-indexed literatures from Google and Google scholar. Quality of studies were independently assessed using Cochrane Risk of Bias Assessment Tool. A qualitative synthesis and quantitative pooled estimation were used to measure the effect of phone messaging on TB treatment success rate. PRISMA flow diagrams were used to summarize article selection process.ResultsA total of 1237 articles were identified, with 14 meeting the eligibility criteria for qualitative synthesis. Eight studies with a total of 5680 TB patients (2733 in intervention and 2947 in control groups) were included in meta-analysis. The pooled effect of mobile-phone messaging revealed a small increase in treatment success compared to standard of care (RR 1.04, 95% CI 1.02 to 1.06), with low heterogeneity (I2 = 7%, p < 0.0002). In the review, performance, detection and attrition biases were reported as major risk of biases.ConclusionsMobile-phone messaging showed a modest effect in improving anti-TB treatment success; however, the quality of evidence was low. Further controlled studies are needed to increase the evidence-base on the role of mHealth interventions to improve TB care.Protocol registration numberCRD420170744339. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017074439

"Is there a difference in treatment outcome of tuberculosis patients: Rural Healthcare Providers versus Community Health Workers?"

Introduction:Rural healthcare providers (RHCPs) are the first point of contact for majority of patients in rural parts of India. A total of 75 RHCPs were trained and engaged in Hazaribagh to identify presumptive tuberculosis (TB) patients (PrTBPs) and refer them for diagnosis. Patients diagnosed with TB were initiated on directly observed treatment short course (DOTS) under the programme. Based on patients' choice, the treatment providers were either RHCPs or community health workers (CHWs). In this paper, we aim to compare the treatment outcomes of TB patients who received DOTS from RHCPs with CHWs.Method:This is a retrospective cohort study using secondary data routinely collected through project and Revised National TB Control Programme.Results:Over the period of 24 months, 57 RHCPs continued to be engaged with project and a total of 382 referrals were made out of which 72 (19%) were diagnosed with TB. Based on choice made, 40 (55%) of TB patients chose RHCPs and 32 (45%) CHWs as their treatment provider. The mean successful treatment completion rate was 87% in the RHCP group compared with 81% for CHWs (P value 0.464). The percentages of unsuccessful outcomes were similar for both groups.Conclusions:Our study demonstrates the process to engage RHCPs in TB prevention and care. The study highlights community preference for RHCPs as DOT provider who can produce similar TB treatment success rates as that of CHWs identified by programme.

Treatment outcomes and factors associated with mortality among individuals with both TB and HIV in the antiretroviral era in Thailand

ObjectiveThis study aimed to compare treatment outcomes and factors associated with mortality in HIV-1-positive and HIV-1-negative individuals. MethodsWe conducted a cohort study between July 2008 and December 2016. Logistic regression was used to determine factors associated with outcomes and death after tuberculosis (TB) treatment. ResultsA total of 996 individuals with TB, 228 (22.9%) with HIV-1 co-infection and 770 (77.1%) who were HIV-1 negative were reviewed. The overall treatment success rate was 74.3%. The HIV-1-negative individuals with TB had significantly higher treatment success rates (77.2% vs 64.5%, P>0.001). Using logistic regression analysis, age >50 years (adjusted odds ratio [aOR] 3.89, 95% confidence interval [CI] 2.24–6.76; P>0.001), body weight ≤45kg (aOR 2.19, 95% CI 1.14–4.19; P=0.02) and HIV-1-positive status (aOR 3.31, 95% CI 1.84–5.91; P>0.001) were independently associated with death during TB treatment. Among HIV-1-positive individuals, not undergoing antiretroviral therapy (ART), having diabetes and a CD4 T cell count of >50 cells/mm3 were significantly associated with death. ConclusionIndividuals who had both TB and HIV-1 in Thailand had lower TB treatment success and higher mortality rates compared with individuals with TB without HIV-1. Strategies to improve ART uptake and to reduce risk of developing active TB among individuals with advanced HIV-1 infection should be scaled up.

Predictors for Pulmonary Tuberculosis Treatment Outcome in Denmark 2009\u20132014

Monitoring of tuberculosis (TB) treatment outcome is essential to ensure an effective TB control program. In this nationwide retrospective cohort study from Denmark we present TB treatment outcome rates and risk factors associated with an unfavourable outcome. All patients notified with pulmonary TB from 2009 through 2014 were included. Logistic regression analyses were used to identify risk factors for unfavourable outcome. In total, 1681 pulmonary TB cases were included. TB treatment success rates increased during the study period. In 2014, the treatment success rate reached 85% for new culture positive cases whereas 7% cases interrupted treatment. The mortality decreased during the study period from 12.3% to 4.1%. Several risk factors associated with unfavourable outcome were identified in a multivariable model: male (OR: 2.56), Greenlandic origin (OR: 1.80), abuse of alcohol (OR: 2.90), history of mental disorder (OR: 2.46), and anaemia at time of treatment initiation (OR: 1.92). In a TB low incidence setting such as the Danish, it is important to maintain focus on preventing an unfavourable TB outcome. Patient management and treatment can be optimized by taking into consideration risk factors such as those identified in the present study.

Evaluation of the performance of the National Tuberculosis Program of Liberia during the 2014\u20132015 Ebola outbreak

BackgroundLiberia is among the three west African countries which were crippled by the Ebola Virus Disease (EVD) outbreak of 2014. One of the programs which was affected by the EVD outbreak was the National Leprosy and Tuberculosis Control Program (NLTCP). Determining the magnitude of the impact of EVD on the NLTCP performance is crucial in restoring the service and in devising effective post EVD strategies. The purpose of the study was to analyse the impact of EVD outbreak on the performance of the NLTCP of the Ministry of Health (MOH) OF Liberia.MethodsA cross sectional study design was conducted in 2016 using both quantitative and qualitative methods. Quantitative data was used for the Tuberculosis (TB) program evaluation before EVD (2012–2013) and during EVD (2014–2015). Qualitative data was used to complement the data obtained for the quantitative study. Descriptive statistical analyses of quantitative data were conducted using Microsoft Excel.ResultsNotified TB cases of all forms decreased from 7822 in 2013 to 4763 and 6118 in 2014 and 2015 respectively. The number increased to 7180 and 7728 in 2016 and 2017 respectively. The TB treatment success rate was 71 and 61% in 2014 and 2015 respectively compared to the 83% in 2013. The treatment success rate was 77% in 2016. The loss to follow up (LTFU) was as high as 47% in some regions which were highly affected by the EVD outbreak. The national average LTFU was 5–10% in 2012–2013 and 16 and 21% in 2014 and 2015 respectively. The percentage of TB patients with known HIV result decreased from 75% in 2013 to 74 and 42% in 2014 and 2015 respectively. TB culture and drug susceptibility testing service was interrupted throughout the outbreak. The results of the focal group discussions and interviews conducted in our study also indicated that the TB case finding and the TB treatment outcome was significantly affected by the EVD outbreak.ConclusionNotified TB cases and treatment outcome was significantly affected by the EVD outbreak which occurred in 2014 and 2015 in Liberia. Effective restoration strategies should be developed in order to improve the TB case finding and treatment outcome.

Tuberculosis treatment outcome and its associated factors among people living with HIV and AIDS in Fako Division of Cameroon.

BackgroundTuberculosis (TB) and HIV co-infection challenges treatment and worsens the outcome of TB treatment. This study aimed to assess the outcome of TB treatment and factors facilitating treatment success among people living with HIV/AIDS in Fako Division of the South West Region of Cameroon.MethodsA hospital-based retrospective cohort study was conducted by manually reviewing medical records of HIV/TB co-infected patients from January 2010 to September 2017. A structured data collection form was used to review the medical records of HIV patients co-infected with TB aged 10 years and older. Patients with incomplete files were dropped from the study. Treatment success was defined as the sum of patients who were declared cured and those who had completed treatment, as per the World Health Organization’s recommendations. Data were analyzed using Statistical Package for Social Sciences version 21. Bivariate and multivariate logistic regression model was carried out to identify factors facilitating successful TB treatment outcome. Significance was obtained through adjusted odds ratio with its 95% confidence interval and a p<0.05.ResultsA total of 2,986 files were reviewed but 2,928 (98.1%) were retained. Out of the 2,928 medical files of adult TB patients reviewed, 1,041 (35.6%, [95% CI 33.8%-37.3%]) were HIV/TB co-infected. The 1,041 co-infected patients had a mean age of 37.07 (SD of10.02) years and 56.3% were females. The treatment outcome of TB patients were 795(76.4%) cured, 23(2.2%) treatment completed, 99(9.5%) were lost to follow-up, 16 (1.5%) failed, 72(6.9%) died and 36(3.5%) transferred out. A successful treatment outcome was achieved in 818(78.6%,[95% CI: 76.0%–81.0%]) patients. Being a female [COR 1.61, 95% CI: 1.19–2.17, p = 0.002], receiving TB treatment in 2014 [COR 2.00, 95% CI: 1.11–3.60, p = 0.021] and 2015 [COR 2.50, 95% CI: 1.39–4.50, p = 0.002], having relapsed TB infection [COR 0.46, 95% CI: 0.23–0.93, p = 0.031], receiving ART [COR 1.95, 95% CI: 1.28–2.97, p = 0.002] and Cotrimoxazole [COR 2.03, 95% CI: 1.12–3.66, p = 0.019] were factors significantly associated with successful treatment. After adjusting for confounders, successful treatment outcome were associated with being a female [AOR 1.6; 95% CI: 1.21–2.22, p = 0.001], diagnosis of TB in 2014 [AOR 1.90; 95% CI: 1.04–3.45, p = 0.036] and 2015 [AOR 2.43; 95% CI: 1.33–4.43, p = 0.004].ConclusionThere is a high TB treatment success rate among HIV/TB co-infected patients in our setting, although below the target set by the WHO. Specific interventions aimed at enhancing patient outcomes are recommended.

Spatiotemporal patterns and ecological factors of tuberculosis notification: A spatial panel data analysis in Guangxi, China.

BackgroundGuangxi is one of the provinces having the highest notification rate of tuberculosis in China. However, spatial and temporal patterns and the association between environmental diversity and tuberculosis notification are still unclear.ObjectiveTo detect the spatiotemporal pattern of tuberculosis notification rates from 2010 to 2016 and its potential association with ecological environmental factors in Guangxi Zhuang autonomous region, China.MethodsWe performed a spatiotemporal analysis with prediction using time series analysis, Moran’s I global and local spatial autocorrelation statistics, and space-time scan statistics to detect temporal and spatial clusters of tuberculosis notifications in Guangxi between 2010 and 2016. Spatial panel models were employed to identify potential associating factors.ResultsThe number of reported cases peaked in spring and summer and decreased in autumn and winter. The predicted number of reported cases was 49,946 in 2017. Moran's I global statistics were greater than 0 (0.363–0.536) during the study period. The most significant hot spots were mainly located in the central area. The eastern area exhibited a low-low relation. By the space-time scanning, the clusters identified were similar to those of the local autocorrelation statistics, and were clustered toward the early part of 2016. Duration of sunshine, per capita gross domestic product, the treatment success rate of tuberculosis and participation rate of the new cooperative medical care insurance scheme in rural areas had a significant negative association with tuberculosis notification rates.ConclusionThe notification rate of tuberculosis in Guangxi remains high, with the highest notification cluster located in the central region. The notification rate is associated with economic level, treatment success rate and participation in the new cooperative medical care insurance scheme.

Incidence and Risk Factors Associated With Tuberculosis Treatment Outcomes Among Prisoners

Background Prison represents an important setting for tuberculosis (TB) control. Higher TB rates have been reported in prison when compared with general population. Aims and objective The current study evaluates the incidence of TB among prison inmates from 4 states of Malaysia to identify factors associated with Mycobacterium tuberculosis infection and treatment outcomes. Methodology A multicenter, cross-sectional, retrospective study was conducted in the 11 prisons in 4 Malaysian states, which were selected based on high burdens of TB in Malaysia (Sabah, Sarawak, Pulau Pinang, and Selangor). Patients with confirmed TB were selected for the study based on tuberculin skin testing and further established by chest radiograph and positive sputum and culture test results. Results A total of 405 inmates were diagnosed as having TB, with most them being male inmates (n = 397; 98%). The mean ± SD age of TB inmates was 39.28 ± 10.12 years. The sample was ethnically diverse and consisted mostly of Malays (203; 50.1%) followed by Chinese (98; 24.2%), Indians (64; 15.8%), and other ethnicities (40; 9.9%). Of the total 405 TB inmates, most belonged to the Selangor state prison (n = 312; 77%), with an incidence rate of 755/100,000. The overall incidence of TB among 4 state prisons in Malaysia was 440/100,000. Treatment outcome for 279 (68.8%) TB inmates was successful, 31 (7.7%) were defaulters, 12 (3%) were transferred out, 34 (8.4%) died, and treatment of TB for 49 (12.1%) inmates was continued. On univariate analysis, patient sex (odds ratio [OR], 2.21; 95% confidence interval [CI], 0.2–6.8; P &lt; 0.001), age group (OR, 1.65; CI, 1.08–2.53; P = 0.02), area (OR, 1.08; CI, 0.3–3.1; P &lt; 0.001), pulmonary TB (OR, 1.96; CI, 1.2–3.1; P = 0.05), extrapulmonary TB (OR, 0.53; CI, 0.3–0.8; P = 0.015), and TB with diabetes mellitus (OR, 2.21; CI, 0.7–2.7; P = 0.01) were statistically significant as predictors of treatment outcomes. These variables were further analyzed on multivariate analysis, and patient age group (OR, 1.60; CI, 1.0–2.5; P = 0.02) was a more likely factor that affected treatment outcome. Conclusion Low TB treatment success rates and multiple factors affecting treatment outcomes refer to the fact that attention is needed in improving existing medical setup at prisons.

Dolutegravir-based Antiretroviral Therapy for Patients Coinfected With Tuberculosis and Human Immunodeficiency Virus: A Multicenter, Noncomparative, Open-label, Randomized Trial.

The concurrent treatment of tuberculosis and human immunodeficiency virus (HIV) is challenging, owing to drug interactions, overlapping toxicities, and immune reconstitution inflammatory syndrome (IRIS). The efficacy and safety of dolutegravir (DTG) were assessed in adults with HIV and drug-susceptible tuberculosis. International Study of Patients with HIV on Rifampicin ING is a noncomparative, active-control, randomized, open-label study in HIV-1-infected antiretroviral therapy-naive adults (CD4+ ≥50 cells/mm3). Participants on rifampicin-based tuberculosis treatment ≤8 weeks were randomized (3:2) to receive DTG (50 mg twice daily both during and 2 weeks after tuberculosis therapy, then 50 mg once daily) or efavirenz (EFV; 600 mg daily) with 2 nucleoside reverse transcriptase inhibitors for 52 weeks. The primary endpoint was the proportion of DTG-arm participants with plasma HIV-1-RNA <50 copies/mL (responders) by the Food and Drug Administration Snapshot algorithm (intent-to-treat exposed population) at Week 48. The study was not powered to compare arms. For DTG (n = 69), the baseline HIV-1 RNA was >100 000 copies/mL in 64% of participants, with a median CD4+ count of 208 cells/mm3; for EFV (n = 44), 55% of participants had HIV-1 RNA >100 000 copies/mL, with a median CD4+ count of 202 cells/mm3. The Week 48 response rates were 75% (52/69, 95% confidence interval [CI] 65-86%) for DTG and 82% (36/44, 95% CI 70-93%) for EFV. The DTG nonresponses were driven by non-treatment related discontinuations (n = 10 lost to follow-up). There were no deaths or study drug switches. There were 2 discontinuations for toxicity (EFV). There were 3 protocol-defined virological failures (2 DTG, no acquired resistance; 1 EFV, emergent resistance to nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors). The tuberculosis treatment success rate was high. Tuberculosis-associated IRIS was uncommon (4/arm), with no discontinuations for IRIS. Among adults with HIV receiving rifampicin-based tuberculosis treatment, twice-daily DTG was effective and well tolerated. NCT02178592.

Effectiveness of community-based DOTS strategy on tuberculosis treatment success rates in Namibia.

<sec id="st1"> <title>SETTING</title> DOTS is a key pillar of the global strategy to end tuberculosis (TB). </sec> <sec id="st2"> <title>OBJECTIVE</title> To assess the effectiveness of community-based compared with facility-based DOTS on TB treatment success rates in Namibia. </sec> <sec id="st3"> <title>METHODS</title> Annual TB treatment success, cure, completion and case notification rates were compared between 1996 and 2015 using interrupted time series analysis. The intervention was the upgrading by the Namibian government of the TB treatment strategy from facility-based to community-based DOTS in 2005. </sec> <sec id="st4"> <title>RESULTS</title> The mean annual treatment success rate during the pre-intervention period was 58.9% (range 46-66) and increased significantly to 81.3% (range 69-87) during the post-intervention period. Before the intervention, there was a non-significant increase (0.3%/year) in the annual treatment success rate. After the intervention, the annual treatment success rate increased abruptly by 12.9% (P < 0.001) and continued to increase by 1.1%/year thereafter. The treatment success rate seemed to have stagnated at ∼85% at the end of the observation period. </sec> <sec id="st5"> <title>CONCLUSION</title> Expanding facility-based DOTS to community-based DOTS increased annual treatment success rates significantly. However, the treatment success rate at the end of the observation period had stagnated below the targeted 95% success rate. </sec>.

Global epidemiology of tuberculosis, a comparative study of the six WHO regions in 2018

Introduction: Tuberculosis (TB) remains a global emergency and is one of the major threats to human and public health, more than 60 years of its medical treatment, as well as the economic and social development of societies. More than 2 billion individuals are infected with mycobacterium, causing the morbidity and mortality of 10 and 2 million individuals, respectively. The current study was accomplished aiming to investigate the TB disease status and indicators of achieving the goal of ending the TB epidemics by 2035. Methods: This was a comparative study conducted in a library and the main source of information used included the reports published by the World Health Organization (WHO) and its regional organizations profile, the United Nations Development Program (UNDP), World Bank Group (WBG), and studies. Results: The highest incidence rate was in Africa and South-East Asia, with the lowest incidence in the Americas and Europe regions. In the Eastern Mediterranean region, the incidence of extrapulmonary TB (EPTB) was about 10% higher than in other areas. The highest success rate of TB treatment was in the Western Pacific region and the lowest in the United States and Europe. Conclusion: Over 1 billion US dollars have been spent in funding for the fight against TB. Health policymakers, especially in the Middle Eastern region, should pay particular attention to allocating national and local resources to this disease and rely less on international and humanitarian resources. In order to achieve the goal of ending the TB epidemic END-TB 2035, in addition to addressing the economic and social well-being of citizens, it is essential to focus on early detection and diagnosis of disease and effective treatment with strategy implementation [Directly Observed Treatment Short course (DOTS)].

Factors Associated with Success Rate for Tuberculosis Treatment in Hospital: A Directly Observed Treatment Short Tuberculosis Prevention Strategy in Central Java

Background : Tuberculosis (TB) is a major health problem throughout the world. Hospitals and pulmonary clinics contribute significantly to the number of patients from all positive smear cases. Hospital performance in TB control is assessed using treatment success rates. The purpose of this study is to find out an overview of hospital performance factors that influence the success of hospitals in TB control in Central Java. Subjects and Method: The study design was a descriptive analytical epidemiology with a retro­spective cohort design. The samples were taken in total sampling. The subjects were 158 hospitals in Central Java Province that used the DOTS strategy. The variable assessment instrument from the 2010 TB Sub-Directorate of the Ministry of Health's checklist was taken in January-February 2018. The data were linked to TB data from the Central Java Provincial Health Office in 2013 and 2016. Treatment success rates were stated to be good if the value was %85% Results: There were 110 hospitals with complete data in 2013 and 2016. Good success rates (>85%) in 2013 were achieved by 59 (53.60%) hospitals in 2013, in 2016 it decreased, only 43 (39.10%) hospitals were achieved. There was no significant relationship between the commitment and organization of the DOTS Hospital team, treatment, medical supervision, internal/external networks, and health facilities with the success rate of TB treatment, in which in this study, the value of p > 0.05. The type of hospital was significantly associated with treatment success rates in 2013, in which the lower type of hospital, the better the success rate of TB treatment. Conclusion: Because of the low number of hospitals that achieve good success rates (>85%), more detailed identification of risk factors is needed. Keywords: tuberculosis, success rate, hospitals Correspondence: Reviono. Department of Pulmonology and Medical Respiration, Universitas Sebelas Maret Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: reviono@staff.uns.ac.id. Mobile: +6281­847­4671. Journal of Epidemiology and Public Health (2019), 4(4): 283-295 https://doi.org/10.26911/jepublichealth.2019.04.04.03

The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil

BackgroundEvidence suggests that social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper...

Predictors of tuberculosis treatment success among HIV-TB co-infected patients attending major tuberculosis treatment sites in Abeokuta, Ogun State, Nigeria.

Introductiontuberculosis (TB) is the commonest opportunistic infection and cause of death in patients with Human Immunodeficiency Virus (HIV) in developing countries. World Health Organization (WHO) recommends 85% treatment success rate for all TB cases as an indicator of TB control. The study aimed at determining TB treatment success rate among TB-HIV co-infected patients and identifying predictors of successful treatment among patients in TB treatment sites in Abeokuta, Nigeria.Methodsit was a cross-sectional study among HIV-TB co-infected patients in the two major health facilities in Abeokuta, Nigeria. Socio-demographic characteristics with treatment history were obtained using a semi-structured questionnaire. Sputum samples were collected and tested for acid-fast bacilli (AFB) using a standard method according to national guideline for TB treatment to determine treatment success rate. Treatment success was defined as any HIV positive patient with a diagnosis of TB by acid-fast bacilli (AFB) smear positivity at diagnosis, who after 6 months of complete treatment becomes smear negative. Adjusted odds ratio was used to identify independent predictors of successful treatment outcome with confidence interval set at 95% and level of significance set at P < 0.05.Resultsa total of 109 HIV-TB co-infected patients were enrolled for this study. Fifty-nine (54.1%) were females, 106 (97.3%) were newly treated for TB. Eighty-five (78.0%) were treated in a private health facility. A total of 91 had successful treatment outcome with a treatment success rate (TSR) of 83.5%. Eleven (10.1%) died, 5 (4.6%) defaulted, 1 (0.9%) failed treatment, 1 (0.9%) was transferred out. Successful treatment was associated with being newly registered (i.e. receiving TB treatment under the DOTS program for the first time), receiving TB treatment for the first time (adjusted OR = 18, 95%CI: 1.5-482.3) and being treated at a private health facility (adjusted OR = 14.1, 95%CI 4.27-48.4).Conclusiontreatment success rate of TB among HIV-TB co-infected patients in this study slightly falls below the WHO target. Registration status and health facility type were predictors of treatment outcome among study patients. Patients and healthcare workers in public facilities were educated on HIV-TB co-infection management.

Health scenario of Karnali Province

Introduction: Although Karnali is an old civilization of Nepal, this province has low human development indexes and the indicators of health are low. This study was carried out to comprehend the trend of public health indicators and disease pattern of Karnali Province.&#x0D; Methods: Descriptive study using provincial three years’ health data were reviewed from all the 10 districts of Karnali Province using per forma. Data entered in Microsoft Excel software were transferred into the statistical package for social sciences version 21 and descriptive analysis was carried out.&#x0D; Results: Previous three years’ data were analyzed. The last years’ results were BCG coverage was 106.0%, DPT/Hepa B was 93.0%, 95.0%, tetanus toxoid (TT) 2 &amp; tetanus toxoid 2+ was 82.0%, 0-11 months' growth monitoring was 126.0%, 0-23 months' underweight children was 8.0%, pneumonia among new acute respiratory infection was 24.0% prevalence of acute respiratory infection was 949/1,000, prevalence of diarrhea was 709/1,000 and severe dehydration among diarrhea was 0.9%. Four Antenatal chick up was 55.0% institutional delivery was 67.0%, delivery by skill birth attendant was 56.0%, health examination within 24 hours of delivery was 65.0%, and contraceptive prevalence (CPR) rate was 35.0%. Likewise, treatment success rate of tuberculosis was 86.0%, new case detection for rate/100,000 tuberculosis was 0.5, HIV Incidence rate/10,000 was 5.3 and outpatient department attendance was 83.0%. Among top 10 diseases, respiratory infection was the first with 14.8%, followed by acute peptic disorders 10.4%, headache 7.9%, worm infestations 7.2% and fall injuries/ fractures found 5.9%.&#x0D; Conclusions: The indicators of health condition of Karnali Province are markedly low in comparison to the other provinces as well as the national figure. The utilization of public health services has to be reinforced in the province and districts.