Unsuccessful TB Treatment Outcome Research Articles

Social and biological factors associated with unsuccessful TB treatment outcome in Ireland 2011-2021

Abstract Background Tuberculosis (TB) treatment success rates are crucial for TB control programme evaluations. The World Health Organisation sets targets of > 90% but Ireland remains below 70%. We analysed notifications from the Irish National TB Surveillance System from 2011-2021 to explore factors associated with successful treatment outcome in Ireland. Methods We selected potential predictor variables based on clinical relevance and literature review. We examined each predictor's unadjusted association with treatment success using univariable logistic regression. We used backwards elimination to remove predictors that failed to remain significant in multivariable logistic regression. Treatment success was defined as treatment completed or cured, while unsuccessful treatment was defined as treatment failed, treatment interrupted, transferred out and died from any cause. We used Stata for analysis. Results Between 2011-2021, 52% of cases were successfully treated, 10.7% were unsuccessfully treated and treatment outcome was not reported for 37%. Treatment outcome completeness declined significantly between 2019-2021. Univariable analysis showed successfully treated cases had higher odds of being a migrant (OR:1.9; 1.5-2.5), being linked to outbreaks (OR:1.9; 1.2-3.0), being a contact of a case (OR: 1.0-2.5;), having a normal X-ray (OR:1.7;1.1-2.6) and being an outpatient (OR:3.0;2.2-4.2). Significant predictors of unsuccessful treatment in the final model were age >70 years, unemployment, immunesuppression and any anti-TB drug resistance. Conclusions Surveillance data shows that Ireland fails to meet the WHO target of > 90% treatment success with high levels of missing data. Data quality improvement initiatives are needed to reverse the decline in completeness associated with the Covid-19 pandemic period so control programmes can robustly evaluate performance. Additional supports should be considered for patients who are older, unemployed, immunesuppressed or with drug resistant TB. Key messages • Additional patient supports should be considered for patients who are unemployed, age 70 years and older, immunesuppressed or with drug resistant forms of TB. • Ireland fails to meet the WHO TB treatment success target with high levels of missing data. Treatment outcome completeness needs to be improved so control programmes can robustly evaluate performance.

Factors associated with the unsuccessful TB treatment outcomes in the northern regions of Namibia: a mixed methods study

BackgroundTuberculosis (TB) is among the leading causes of death globally. The disease has a huge burden in Namibia, with a case notification rate of at least 442 per 100,000. To date, Namibia is among the countries with the highest global TB burden, despite all efforts to reduce it. This study aimed to determine the factors associated with the unsuccessful treatment outcomes of the Directly Observed Therapy Short course (DOTS) programme in the Kunene and Oshana regions.MethodsThe study utilised a mixed-methods explanatory-sequential design to collect data from all TB patient records and healthcare workers who work directly with the DOTS strategy for TB patients. The relationship between independent and dependent variables was analysed using multiple logistic regression analysis, while interviews were analysed using inductive thematic analysis.ResultsThe overall treatment success rates of the Kunene and Oshana regions throughout the review period were 50.6% and 49.4%, respectively. The logistic regression analyses showed that in the Kunene region, the type of DOT used (Community-based DOTS) (aOR = 0.356, 95% CI: 0.835–2.768, p = 0.006) was statistically significant with the unsuccessful treatment outcomes. While in the Oshana region, age groups 21–30 years old (aOR = 1.643, 95% CI = 1.005–2.686, p = 0.048), 31–40 years old (aOR = 1.725, 95% CI = 11.026–2.9, p = 0.040), 41–50 years old (aOR = 2.003, 95% CI = 1.155–3.476, p = 0.013) and 51–60 years old (aOR = 2.106, 95% CI = 1.228–3.612, p = 0.007) had statistically significant associations with the poor TB-TO. Inductive thematic analysis revealed that patients in the Kunene region were challenging to reach owing to their nomadic lifestyle and the vastness of the area, adversely affecting their ability to observe TB therapy directly. In the Oshana region, it was found that stigma and poor TB awareness among adult patients, as well as mixing anti-TB medication with alcohol and tobacco products among adult patients, was a prevalent issue affecting TB therapy.ConclusionThe study recommends that regional health directorates embark on rigorous community health education about TB treatment and risk factors and establish a robust patient observation and monitoring system to enhance inclusive access to all health services and ensure treatment adherence.

Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis.

This review aimed to summarize and estimate the TB treatment success rate and factors associated with unsuccessful TB treatment outcomes in Africa. Potentially eligible primary studies were retrieved from PubMed and Google Scholar. The risk of bias and quality of studies was assessed using The Joanna Briggs Institute’s (JBI) appraisal criteria, while heterogeneity across studies was assessed using Cochran’s Q test and I2 statistic. Publication bias was checked using the funnel plot and egger’s test. The protocol was registered in PROSPERO, numbered CRD42019136986. A total of 26 eligible studies were considered. The overall pooled estimate of TB treatment success rate was found to be 79.0% (95% CI: 76–82%), ranging from 53% (95% CI: 47–58%) in Nigeria to 92% (95% CI: 90–93%) in Ethiopia. The majority of unsuccessful outcomes were attributed to 48% (95% CI: 40–57%) death and 47% (95% CI: 39–55%) of defaulter rate. HIV co-infection and retreatment were significantly associated with an increased risk of unsuccessful treatment outcomes compared to HIV negative and newly diagnosed TB patients with RR of 1.53 (95% CI: 1.36–1.71) and 1.48 (95% CI: 1.14–1.94), respectively. TB treatment success rate was 79% below the WHO defined threshold of 85% with significant variation across countries. Countries need to explore contextual underlining factors and more effort is required in providing TB preventive treatment, improve case screening and linkage for TB treatment among HIV high-risk groups and use confirmatory TB diagnostic modality. Countries in Africa need to strengthen counseling and follow-up, socio-economic support for patients at high risk of loss to follow-up and poor treatment success is also crucial for successful TB control programs.

A five-year audit of gaps in HIV testing and associations with TB treatment outcomes in Armenia, 2015-2019.

Poor human immunodeficiency virus (HIV) testing practices and underreporting of HIV-related data in TB information systems remain barriers to effective care for TB-HIV co-infected patients. HIV testing and recording practices in national TB program have not been formally evaluated in Armenia. This study aimed to assess the recording completeness of HIV testing and HIV status in the national TB program electronic database, and to determine trend in HIV testing and the association between HIV testing and treatment outcomes for all TB patients registered in Armenia (2015-2019). A cohort study of TB patients using routine programmatic data from the national TB program of Armenia. From 2015 to 2019, the electronic database was completed for HIV testing and HIV status by 48.1% and 97.5%, respectively. Of all registered TB patients 93.6% were tested for HIV. Of a total 4,674 patients, 1,085 (23.2%) had unsuccessful outcomes. Patients with HIV status "not tested" and "not recorded" compared to HIV "negatives" had 1.76 (95%CI 1.42-2.11) and 1.6 (95%CI 1.20-2.06) times higher risk of unsuccessful outcomes, respectively. Lost to follow-up was the most frequent unsuccessful outcome in HIV status "not tested" group. An analysis of nationwide data revealed incompleteness of the national TB electronic database for HIV data. Patients with HIV status "not tested" and "not recorded" had higher risk of unsuccessful TB treatment outcomes. Upgrade of the electronic database with information on key indicators of TB-HIV services will facilitate improved monitoring and reporting.

Trends of unsuccessful treatment outcomes and associated factors among tuberculosis patients in public hospitals of Bale Zone, Southeast Ethiopia: A 5-year retrospective study

IntroductionTuberculosis (TB) is a curable disease caused by the tubercle bacillus and its treatment is designed to cure, interrupt transmission, and prevent drug resistance. These aims have not yet been achieved in many regions of the world, particularly in developing countries like Ethiopia. Thus, this study was designed to assess the trends of unsuccessful treatment outcomes and associated factors among patients with TB in two public hospitals in the Bale zone, southeast Ethiopia. MethodsA 5-year retrospective data among 1281 patients with TB who registered and started treatment (from July 2013 to June 2018/19) in two selected Bale zone hospitals was retrieved. Together with descriptive statistics, binomial and multinomial logistic regression modeling were carried out using STATA version 14 to estimate the odds ratio. ResultsThe overall unsuccessful TB treatment outcomes in this study was 10.4% and moderately decreased over the year of treatment (from 14.1% to 8.4%, x2 = 7.35, and p = 0.011). Approximately 34 (7.6%) of pulmonary positive and 34 (7.4%) of pulmonary negative TB patients had experienced treatment failure and death, respectively. The level of the hospital, patients with smear-negative and extrapulmonary, transferred in, aged, and human immunodeficiency virus status were found to have a statistically significant association with unsuccessful treatment outcomes of patients with TB. ConclusionIn this study, approximately one-tenth of patients with TB had unsuccessful treatment outcomes that moderately declined over the year of treatment. Strengthening control efforts like counseling during the intensive and continual phases of treatment and scheduling home visits is recommended.

Effect of Diabetes Mellitus on Tuberculosis Treatment Outcomes among Tuberculosis Patients in Kelantan, Malaysia.

Background:There is growing evidence that DM may play an important role in the occurrence of unsuccessful TB treatment outcomes. This study was undertaken to examine the prevalence of DM among TB population, compare the profile of TB patients with and without DM and determine the effect of DM on unsuccessful treatment outcomes among TB patients in Kelantan state, Malaysia from 2012 to 2016.Methods:A cross sectional study was conducted in Sep 2017 using data from registered TB cases in Kelantan state, Malaysia from 2012 to 2016. The profile of TB patients with and without DM were compared in univariable analysis. Multiple logistic regression was used to determine association between DM and unsuccessful treatment outcomes.Results:A total of 1854 TB patients were diagnosed with DM. The annual proportion was ranging from 26 to 29%. TB patients with DM had an older age, live single, low educational status, poor chest x ray finding and diagnosed with smear positive sputum compared to TB patients without DM. TB patients with DM had three times higher risk to develop unsuccessful TB treatment outcomes compared to TB patients without DM (95% CI 2.47–3.58; P = 0.012) in multivariable analysis.Conclusion:Those with DM had the worst prognosis of TB outcomes among the significant risk factors. TB control program in Malaysia will need to expand efforts to focus on treatment of TB-DM patients to improve their cure rates in order to achieve the goals of tuberculosis elimination.

Tuberculosis treatment outcomes among prisoners and general population in Zomba, Malawi

BackgroundTB remains a major global health problem. It is particularly prevalent in prisons in sub-Saharan Africa due to overcrowding, malnutrition, high HIV prevalence and insufficient medical services. Prisoners have experienced worse TB treatment outcomes than the general population. The researchers investigated the TB treatment outcomes and predictors of unsuccessful treatment outcomesamong prisoners and the general population in Zomba, Malawi.MethodsWe retrospectively reviewed TB registers of prisoners and the general population diagnosed with TB from January 2011 to December 2016 at Zomba Maximum Central Prison and Zomba Central Hospital, Malawi. The study used routinely collected data extracted from national, standardized TB treatment monitoring tools. Successful treatment outcome was classified as the total for cured and completed treatment while unsuccessful treatment outcome was classified as the total of deaths and treatment failures. We used descriptive statistics to compare the demographics and TB treatment parameters among prisoners and non – prisoners and computed multivariate analysis to predict the independent factors of unsuccessful treatment outcomes.ResultsOf 1652 registered cases, 27% were prisoners (all males) and 72% were non-prisoners (58% males). The median age was 35 years (IQR: 29–42); 76% were Pulmonary TB cases (78% among prisoners vs 75% among general population); 83% were new TB cases (77% among prisoners vs 86% among general population); and 65% were HIV positive (50% among prisoners vs 71% among general population). Regarding treatment outcome, 1472 (89%) were cured and/or completed treatment (93% among prisoners vs 88% among general population), 2(0.2%) were treatment failures, 122 (8%) died (5% among prisoners vs 8% among general population) and 55 (3%) were not evaluated (1% among prisoners vs 4% among general population). Unsuccessful TB treatment outcomes were associated with age greater than 35 years (aOR = 0.68: 95% C.I: 0.58–0.80), Extra-Pulmonary TB (aOR = 1.69: 95% C.I: 1.08–2.63) andHIV positive status (aOR = 0.63: 95% C.I: 0.42–0.94).ConclusionMaximum prisons provide a stable population that can be easily monitored throughout the course of TB treatment. Good TB treatment outcomes which are comparable to the general population can be achieved among Malawian prisoners despite the challenging prison conditions.

Tuberculosis Treatment Outcomes and Associated Factors among TB Patients Attending Public Hospitals in Harar Town, Eastern Ethiopia: A Five-Year Retrospective Study.

Introduction Tuberculosis remains a major public health threat throughout the world particularly in developing countries. Evaluating the treatment outcome of tuberculosis and identifying the associated factors should be an integral part of tuberculosis treatment. Objectives The aim of this study was to assess the treatment outcome of tuberculosis and its associated factors among TB patients in the TB clinics of Harar public hospitals, Eastern Ethiopia, 2017. Methods A retrospective document review was conducted in two public hospitals of Harar town, located 516 km east of Addis Ababa. A systematic random sampling technique was used to select the document of TB patients who were registered in the hospitals from 1st of January, 2011, to 30th of December, 2015. The data were collected using a pretested structured data extraction format. SPSS Version 21 for window was used for data processing. Bivariate and multivariate analysis with 95% confidence interval was employed in order to infer the associations between TB treatment outcome and potential predictor variables. Results One thousand two hundred thirty-six registered TB patients' documents were reviewed. Of these, 59.8% were male, 94.2% were urban dwellers, 97% were new cases, 61.2% were presented with pulmonary TB, and 22.8% were HIV positive. Regarding the treatment outcome, 30.4% were cured, 62.1% completed their treatment, 3.9% died, 2.4% were defaulted, and the remaining 1.2% had failed treatment. The overall rate of the treatment success among the patients was 92.5%. In the present study, being female (AOR = 1.89, 95% CI: 1.14 - 3.14), having pretreatment weight of 20 – 29 kg (AOR = 11.03, 95% CI: 1.66 - 73.35), being HIV negative (AOR = 6.50, 95% CI: 3.95 - 10.71), and being new TB patient (AOR = 3.22 95% CI: 1.10 - 9.47) were factors independently associated with successful treatment outcome. On the other hand, being in the age group 54 – 64 years (AOR =10.41, 95% CI: 1.86 - 58.30) and age greater than 65 years (AOR =24.41, 95% CI: 4.19 - 142.33) was associated with unsuccessful TB treatment outcome. Conclusion In the current study, the rate of successful TB treatment outcome was acceptable. This rate should be maintained and further improved by designing appropriate monitoring strategies.

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.

Treatment Outcome and Associated Factors among TB Patients in Ethiopia: Hospital-Based Retrospective Study

Background: Tuberculosis remains a major global health problem and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of mortality worldwide. For effective tuberculosis control, it is a pre-requisite to detect the cases as early as possible, and to ensure that the tuberculosis patients complete their treatment and get cured. However, in many resource-constrained settings treatment outcome for tuberculosis has not been satisfactory. Objective: The aim of the study was to assess the treatment outcome of tuberculosis and investigate the association of demographic and clinical factors with treatment success of patients enrolled in selected hospitals, Ethiopia. Methods: A fifteen-year retrospective register based historical data were collected through medical record review from 31 selected hospitals in Ethiopia. Data were analyzed using SPSS version 20 and to investigate the association of demographic and clinical factors with treatment success of patients, multiple logistic regression methods were used. A 𝑝 value of less than 5% was considered as statistically significant in the final model. Result: Out of the 90,191 registered tuberculosis patients (50,167 males and 40,024 females) including all age group, 55.8% had successful treatment outcome and 44.2% had unsuccessful outcome. In the multivariate logistic model, the odds of unsuccessful treatment outcome was relatively higher among patients in the age group of >65 (AOR = 1.283, 95% CI: 1.186-1.387), unknown presumptive MDR TB (AOR=1.17, 95% CI:1.07-1.279) and unknown smear result (AOR=1.706, 95% CI:1.611-1.807); and was lower in age group 15-24 (AOR = 0.818, 95% CI: 0.781-0.857), among female patients (AOR = 0.89, 95% CI: 0..866-0.914) and extra pulmonary TB patients (AOR=0.889, 95% CI:0.848-0.932 as compared to their respective comparison groups. Conclusion: In this study, high proportion of unsuccessful treatment outcome was documented, therefore emphasis has to be given for patients with high risk of unsuccessful TB treatment outcome and targeted interventions should be carried out. All patients’ background characteristics were significantly associated with the treatment success status. And a continuous follow-up of patients with frequent supportive supervision during the course of treatment is recommended.

Effect of glycemic control and type of diabetes treatment on unsuccessful TB treatment outcomes among people with TB-Diabetes: A systematic review.

BackgroundStringent glycemic control by using insulin as a replacement or in addition to oral hypoglycemic agents (OHAs) has been recommended for people with tuberculosis and diabetes mellitus (TB-DM). This systematic review (PROSPERO 2016:CRD42016039101) analyses whether this improves TB treatment outcomes.ObjectivesAmong people with drug-susceptible TB and DM on anti-TB treatment, to determine the effect of i) glycemic control (stringent or less stringent) compared to poor glycemic control and ii) insulin (only or with OHAs) compared to ‘OHAs only’ on unsuccessful TB treatment outcome(s). We looked for unfavourable TB treatment outcomes at the end of intensive phase and/or end of TB treatment (minimum six months and maximum 12 months follow up). Secondary outcomes were development of MDR-TB during the course of treatment, recurrence after 6 months and/or after 1 year post successful treatment completion and development of adverse events related to glucose lowering treatment (including hypoglycemic episodes).MethodsAll interventional studies (with comparison arm) and cohort studies on people with TB-DM on anti-TB treatment reporting glycemic control, DM treatment details and TB treatment outcomes were eligible. We searched electronic databases (EMBASE, PubMed, Google Scholar) and grey literature between 1996 and April 2017. Screening, data extraction and risk of bias assessment were done independently by two investigators and recourse to a third investigator, for resolution of differences.ResultsAfter removal of duplicates from 2326 identified articles, 2054 underwent title and abstract screening. Following full text screening of 56 articles, nine cohort studies were included. Considering high methodological and clinical heterogeneity, we decided to report the results qualitatively and not perform a meta-analysis. Eight studies dealt with glycemic control, of which only two were free of the risk of bias (with confounder-adjusted measures of effect). An Indian study reported 30% fewer unsuccessful treatment outcomes (aOR (0.95 CI): 0.72 (0.64−0.81)) and 2.8 times higher odds of ‘no recurrence’ (aOR (0.95 CI): 2.83 (2.60−2.92)) among patients with optimal glycemic control at baseline. A Peruvian study reported faster culture conversion among those with glycemic control (aHR (0.95 CI): 2.2 (1.1,4)). Two poor quality studies reported the effect of insulin on TB treatment outcomes.ConclusionWe identified few studies that were free of the risk of bias. There were limited data and inconsistent findings among available studies. We recommend robustly designed and analyzed studies including randomized controlled trials on the effect of glucose lowering treatment options on TB treatment outcomes.

Unsuccessful TB treatment outcomes with a focus on HIV co-infected cases: a cross-sectional retrospective record review in a high-burdened province of South Africa

BackgroundSouth Africa did not meet the MDG targets to reduce TB prevalence and mortality by 50% by 2015, and the TB cure rate remains below the WHO target of 85%. TB incidence in the country is largely fuelled by the HIV epidemic, and co-infected patients are more likely to have unsuccessful TB treatment outcomes. This paper analyses the demographic and clinical characteristics of new TB patients with unsuccessful treatment outcomes, as well as factors associated with unsuccessful treatment outcomes for HIV co-infected patients.MethodsA cross-sectional retrospective record review of routinely collected data for new TB cases registered in the Free State provincial electronic TB database between 2009 and 2012. The outcome variable, unsuccessful treatment, was defined as cases ≥15 years that ‘died’, ‘failed’ or ‘defaulted’ as the recorded treatment outcome. The data were subjected to descriptive and logistic regression analyses.ResultsFrom 2009 to 2012 there were 66,940 new TB cases among persons ≥15 years (with a recorded TB treatment outcome), of these 61% were co-infected with HIV. Unsuccessful TB treatment outcomes were recorded for 24.5% of co-infected cases and 15.3% of HIV-negative cases. In 2009, co-infected cases were 2.35 times more at risk for an unsuccessful TB treatment outcome (OR: 2.35; CI: 2.06-2.69); this figure decreased to 1.8 times by 2012 (OR: 1.80; CI: 1.63-1.99). Among the co-infected cases, main risk factors for unsuccessful treatment outcomes were: ≥ 65 years (AOR: 1.71; CI: 1.25-2.35); receiving treatment in healthcare facilities in District D (AOR: 1.15; CI 1.05-1.28); and taking CPT (and not ART) (AOR: 1.28; CI: 1.05-1.57). Females (AOR: 0.93; CI: 0.88-0.99) and cases with a CD4 count >350 (AOR: 0.40; CI: 0.36-0.44) were less likely to have an unsuccessful treatment outcome.ConclusionsThe importance of TB-HIV/AIDS treatment integration is evident as co-infected patients on both ART and CPT, and those who have a higher CD4 count are less likely to have an unsuccessful TB treatment outcome. Furthermore, co-infected patients who require more programmatic attention are older people and males.

Tuberculosis treatment and Smoking, Armenia, 2014–2016

IntroductionTuberculosis and tobacco prove to be increasingly apparent world problems. Armenia is a developing country which is facing issues related to the high rates of tobacco consumption. Moreover, it is among the list of high multi-drug resistant (MDR) Tuberculosis TB burden countries. Treatment success rate in Armenia for sputum smear-positive cases never reached World Health Organization's (WHO) target of 85% in last 15 years. Data from different studies completed across the world suggests that there is an association between smoking and negative treatment outcomes. MethodsThis retrospective study was designed to investigate aforementioned associations between TB treatment outcomes and smoking status of TB patients. Data for the study were derived from the national data available in the electronic database of the Armenian National TB Center. ResultsBased on inclusion and exclusion criteria 992 TB patients registered in 2014 were enrolled in this study. All of them are were TB patients in which 387 were smokers and 605 were non-smokers. Notably, adjusted analysis showed that individuals who smoked during TB treatment had 1.61 higher odds of having unsuccessful TB treatment outcome. Additionally, consistent with the literature, statistically significant association was identified between TB treatment outcome and other well factors such as sputum smear status (OR=2.24, p<0.01), HIV status (OR,=1.87, p<0.01) of patients, etc. ConclusionsThe smoking, HIV positive status, positive sputum smear microscopy test were identified as an important factors associated with the unsuccessful TB treatment outcome in Armenia. It highlights the necessity of having specific restrictions and campaign programs to reduce smoking rates among TB patients in order to improve current TB treatment and care services throughout Armenia.

Treatment Outcomes of Tuberculosis and Associated Factors in an Ethiopian University Hospital

Background. Tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide.Purpose. To assess the outcome of tuberculosis treatment and to identify factors associated with tuberculosis treatment outcome.Methods. A five-year retrospective cross-sectional study was employed and data were collected through medical record review. Data were analyzed using SPSS version 16 and binary and multiple logistic regression methods were used. Apvalue of less than 0.05 was considered as statistically significant in the final model.Results. Out of the 1584 pulmonary TB patients (882 males and 702 females) including all age group, 60.1% had successful outcome and 39.9% had unsuccessful outcome. In the final multivariate logistic model, the odds of unsuccessful treatment outcome was higher among patients of weight category 30–39.9 kg (AOR = 1.51, 95% CI: 1.102–2.065) and smear negative pulmonary TB (AOR = 3.204, 95% CI: 2.277–4.509) and extrapulmonary TB (AOR = 3.175, 95% CI: 2.201–4.581) and retreatment (AOR = 6.733, 95% CI: 3.235–14.013) and HIV positive TB patients (AOR = 1.988, 95% CI: 1.393–2.838) and unknown HIV status TB patients (AOR = 1.506, 95% CI: 1.166–1.945) as compared to their respective comparison groups.Conclusion. In this study, high proportion of unsuccessful treatment outcome was documented. Therefore emphasis has to be given for patients with high risk of unsuccessful TB treatment outcome and targeted interventions should be carried out.

Risk factors for unsuccessful tuberculosis treatment outcome (failure, default and death) in public health institutions, Eastern Ethiopia.

IntroductionUnsuccessful TB treatment outcome is a serious public health concern. It is compelling to identify, and deal with factors determining unsuccessful treatment outcome. Therefore, study was aimed to determine pattern of unsuccessful TB treatment outcome and associated factors in eastern Ethiopia.MethodsA case control study was used. Cases were records of TB patients registered as defaulter, dead and/or treatment failure where as controls were those cured or treatment complete. Multivariate logistic regression models were used to derive adjusted odds ratios (OR) at 95% CI to examine the relationship between the unsuccessful TB treatment outcome and patients’ characteristics.ResultsA total of 990 sample size (330 cases and 660 controls) were included. Among cases (n = 330), majority 212(64.2%) were because of death, 100(30.3%) defaulters and 18(5.5%) were treatment failure. Lack of contact person(OR = 1.37; 95% CI 1.14-2.9, P, .024), sputum smear negative treatment category at initiation of treatment (OR = 1.8; 95% CI 1.3-5.5,P, .028), smear positive sputum test result at 2nd month after initiation treatment (OR = 14; 95% CI 5.5-36, P,0.001) and HIV positive status (OR = 2.5; 95% CI 1.34-5.7, P, 0.01) were independently associated with increased risk of unsuccessful TB treatment outcome.ConclusionDeath was the major cause of unsuccessful TB treatment outcome. TB patients do not have contact person, sputum smear negative treatment category at initiation of treatment, smear positive on 2nd month after treatment initiation and HIV positive were factors significantly associated unsuccessful treatment outcome. TB patients with sputum smear negative treatment category, HIV positive and smear positive on 2nd nd month of treatment initiation need strict follow up throughout DOTs period.

Alcoholism and other socio-demographic risk factors for adverse TB-drug reactions and unsuccessful tuberculosis treatment - data from ten years' observation at the Regional Centre of Pulmonology, Bydgoszcz, Poland.

BackgroundTuberculosis (TB) is one of the most dangerous infectious diseases and has one of the highest mortality rates. For decades a strong association has been evident between certain socio-economic factors and TB adverse events and failure of treatment, yet there is a limited quantity of literature available on this subject, especially in the Polish literature.Material/MethodsWe examined epidemiological data from 2025 TB patients treated at the Regional Centre of Pulmonology in Bydgoszcz, Poland between 2001 and 2010. This article focuses on the association between all forms of unsuccessful TB treatment outcomes or adverse drug reaction (ADR) and socio-demographic characteristics, condition on admission, and other biological, clinical, social, and healthcare access factors.ResultsThe rate of TB-ADR during hospitalization was 38.9%. Multivariate logistic regression analysis showed that age (P<0.001) and alcohol abuse (P=0.007) were independently associated with the occurrence of TB-ADR. The rate of unsuccessful TB treatment was 10.5%. After adjusting for confounding variables, age (P<0.001), alcohol abuse (P=0.002), and education (P=0.01) were significantly associated with unsuccessful treatment. Smoking did not have any significant influence on occurrence of either TB-ADR during hospitalization or unsuccessful treatment.ConclusionsAmong our TB patients treated between 2001 and 2010, alcohol abuse significantly worsened the treatment outcome. This information will be crucial in developing strategies targeted at this demographic group.