Unsuccessful Treatment Outcomes Research Articles

Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records.

Tuberculosis (TB) causes over 1million deaths annually. Providing effective treatment is a key strategy for reducing TB deaths. In this study, we identified factors associated with unsuccessful treatment outcomes among individuals treated for TB in Brazil. We obtained data on individuals treated for TB between 2015 and 2018 from Brazil's National Disease Notification System (SINAN). We excluded patients with a history of prior TB disease or with diagnosed TB drug resistance. We extracted information on patient-level factors potentially associated with unsuccessful treatment, including demographic and social factors, comorbid health conditions, health-related behaviors, health system level at which care was provided, use of directly observed therapy (DOT), and clinical examination results. We categorized treatment outcomes as successful (cure, completed) or unsuccessful (death, regimen failure, loss to follow-up). We fit multivariate logistic regression models to identify factors associated with unsuccessful treatment. Among 259,484 individuals treated for drug susceptible TB, 19.7% experienced an unsuccessful treatment outcome (death during treatment 7.8%, regimen failure 0.1%, loss to follow-up 11.9%). The odds of unsuccessful treatment were higher with older age (adjusted odds ratio (aOR) 2.90 [95% confidence interval: 2.62-3.21] for 85-100-year-olds vs. 25-34-year-olds), male sex (aOR 1.28 [1.25-1.32], vs. female sex), Black race (aOR 1.23 [1.19-1.28], vs. White race), no education (aOR 2.03 [1.91-2.17], vs. complete high school education), HIV infection (aOR 2.72 [2.63-2.81], vs. no HIV infection), illicit drug use (aOR 1.95 [1.88-2.01], vs. no illicit drug use), alcohol consumption (aOR 1.46 [1.41-1.50], vs. no alcohol consumption), smoking (aOR 1.20 [1.16-1.23], vs. non-smoking), homelessness (aOR 3.12 [2.95-3.31], vs. no homelessness), and immigrant status (aOR 1.27 [1.11-1.45], vs. non-immigrants). Treatment was more likely to be unsuccessful for individuals treated in tertiary care (aOR 2.20 [2.14-2.27], vs. primary care), and for patients not receiving DOT (aOR 2.35 [2.29-2.41], vs. receiving DOT). The risk of unsuccessful TB treatment varied systematically according to individual and service-related factors. Concentrating clinical attention on individuals with a high risk of poor treatment outcomes could improve the overall effectiveness of TB treatment in Brazil.

Tuberculosis treatment outcomes and associated factors at Alemgena Health Center, Sebeta, Oromia, Ethiopia.

Tuberculosis (TB) is a global public health problem. Evaluation of TB treatment outcome enables health institutions to measure and improve the effectiveness of TB control programs. This study aimed to assess treatment outcomes of tuberculosis and identify associated factors among TB patients registered at Alemgena Health Center, Oromia, Ethiopia. A retrospective study was conducted; Secondary data were collected from medical records of 1010 TB patients treated at Alemgena Health Center between September 2012 and August 2018, inclusively. Logistic regression was used to identify factors associated with TB treatment outcomes. P-value less than 0.05 was considered statistically significant. The proportion of males and females was almost equal. Among the patients 64.7% were in the age group 15-34, 98% were new cases, 31.2% were smear positive, 13% were HIV positive and 40.3% had extra-pulmonary tuberculosis. 94.2% of the patients had successful treatment outcome, with 26.9% cured and 67.3% treatment completed, whereas 5.8% had unsuccessful treatment outcomes, of whom 4.2% died and 1.5% defaulted. Death rate was higher among patients older than 44 years (10.4%) than among children (0%). In bivariate logistic regression analysis, treatment success rate was 3.582 (95% CI 1.958-6.554, p-value = .000) times higher in the age group 44 and below compared to the age group 45 and above. Treatment success rate exceeded the one targeted by WHO. Age was found to be associated with treatment outcome. Success rate has to be improved for TB patients in the age group greater than 45 years of age.

Undernutrition increases the risk of unsuccessful treatment outcomes of patients with tuberculosis in Ethiopia: A multicenter retrospective cohort study

While undernutrition has been identified as a common risk factor for tuberculosis (TB), its impact on treatment outcomes has yet to be investigated in high TB burden and low-income countries such as Ethiopia. Therefore, this study aimed to investigate the effect of undernutrition on treatment outcomes among patients with TB in northwest Ethiopia. A retrospective cohort study was conducted using data from different hospitals in northwest Ethiopia, for the period from July 2017 to August 2023. A Cox proportional hazard model was performed to determine the effect of undernutrition on TB treatment outcomes, which were defined as a composite of death, treatment failure, or loss to follow-up. A total of 602 patients with TB were included in the analysis. Of these, 367 (60.9%) were male, and 344 (57.1%) were undernourished. Upon completion of the follow-up period, 65 (10.8%) adults with TB had unsuccessful treatment outcomes. After adjusting for potential confounders, patients with undernutrition had a two times higher risk of experiencing unsuccessful treatment outcomes compared to well-nourished patients (AHR: 2.0, 95% CI: 1.2, 3.6). In addition, patients residing in rural areas (AHR: 3.1, 95% CI: 1.7, 5.4), having a history of prior TB treatment (AHR: 2.2, 95%CI: 1.1, 4.1), and the presence of diabetes comorbidity (AHR: 2.4, 95% CI: 1.1, 5.2) were at higher risk of unsuccessful treatment outcomes. Undernutrition increases the risk of unsuccessful treatment outcomes in Ethiopia. This finding suggests that nutritional support during TB treatment can improve successful treatment outcomes in high TB burden and low-income countries such as Ethiopia.

Prevalence, Clinical Characteristics and Determinants of Unsuccessful Treatment Outcomes Among Pulmonary Tuberculosis Patients: A 5-Year Registry-Based Retrospective Cohort Study.

Despite the existence of effective medications, pulmonary tuberculosis (PTB) remains a significant global public health concern, The evaluation and feedback of national TB control programs are crucial, requiring diligent monitoring of TB treatment outcomes and analysis of the factors influencing these outcomes. This study aims to provide valuable insights into the challenges faced by TB patients, which can inform better strategies for treatment and management in the future. We conducted a study in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia (KSA), from January 1, 2018 to December 31, 2023. The study was a registry-based retrospective cohort study. Patients' data were sourced from the National Tuberculosis Registry database of Saudi Arabia. Treatment outcomes were determined as either success or failure, considering clinical evaluation, changes in chest X-rays, and the results of subsequent sputum examinations during follow-up. To evaluate the data, SPSS version 28.0 was used. A total of 427 PTB patients participated in the study. The results show successful treatment outcomes among 88.5% of patients. Among the patients, males exhibited a higher likelihood of treatment failure as compared to females (aOR 1.3; 95%Cl 1.2-1.5, p < 0.001). Patients with positive sputum smear (aOR 1.3; 95%Cl 1.1-1.3 p < 0.00) and the presence of cough were associated with an increased risk of treatment failure (aOR1.5; 95%Cl 1.1-1.4, p < 0.001). This study shows that the percentage of unsuccessful treatment outcomes is high, ie, 11.5%, due to patients' deaths and loss to follow-up. Enhanced supervision and treatment monitoring for tuberculosis patients at high risk of treatment failure can lead to improved treatment success rates in Saudi Arabia.

Frequency, management and impact of adverse events on treatment outcomes in patients with multidrug resistant tuberculosis in Balochistan, Pakistan.

Early detection, monitoring, and managing adverse events (AEs) are crucial in optimising treatment for multidrug-resistant tuberculosis (MDR-TB) patients. To investigate the incidence, factors, management, and impact of AEs on treatment outcomes in MDR-TB patients. This study reviewed the medical records of 275 MDR-TB patients at Fatimah Jinnah Institute of Chest Diseases in Quetta, Pakistan. Patient information was collected using a designed data collection form. Mann-Whitney U and Kruskal-Wallis tests examined the difference in AEs occurrences based on patients' characteristics. Multiple binary logistic regression identified factors associated with unsuccessful outcomes, with statistical significance set at a p-value < 0.05. Almost all patients (99.6%) experienced at-least one AE (median = 4/patient, interquartile range:3-6). The most common were GI disturbance (95.3%), arthralgia (80.4%), body pain and headache (61.8%), ototoxicity (61.4%), psychiatric disturbance (44%), hypokalaemia (40.4%), dermatological reactions (26.2%) and hypothyroidism (21.5%). AEs led to treatment modification in 7.3% patients. Educated patients, those with a history of TB treatment, previous use and resistance to any second-line drug had significantly higher number of AEs. A total of 64.0% were declared cured, 3.6% completed treatment, 19.6% died and 12.7.9% were lost to follow-up. Patients' age of 41-60(OR = 9.225) and >60 years(OR = 23.481), baseline body weight of 31-60 kg(OR = 0.180), urban residence(OR = 0.296), and experiencing ototoxicity (OR = 0.258) and hypothyroidism (OR = 0.136) were significantly associated with unsuccessful treatment outcomes. AEs were highly prevalent but did not negatively impact treatment outcomes. Patients at higher risk of developing AEs and unsuccessful outcomes should receive special attention for its early management.

Why do patients with DR-TB do not complete their treatment? Findings of a qualitative study from Pakistan

BackgroundOne of the major reasons for unsuccessful treatment outcomes among patients with drug-resistant tuberculosis (DR-TB) is the high rate of loss to follow-up (LTFU). However, in Pakistan, no qualitative study...

Unsuccessful tuberculosis treatment outcomes across Brazil's geographical landscape before and during the COVID-19 pandemic: are we truly advancing toward the sustainable development/end TB goal?

BackgroundTuberculosis is one of the most significant infectious diseases for global public health. The reallocation of healthcare resources and the restrictions imposed by the COVID-19 pandemic have hindered access to TB diagnosis and treatment. Increases in unfavorable outcomes of the disease have been observed in Brazil. The objective of this study was to analyze the spatial distribution of unfavorable TB treatment outcomes in Brazil before and during the pandemic.MethodsAn ecological study with spatial analysis was conducted with all 5569 municipalities in Brazil. All reported cases of tuberculosis between January 2010 and December 2021, as well as reported cases of COVID-19 from February 2020 to December 2021, were included. The outcomes studied encompass loss to follow-up, drug-resistant tuberculosis, and death. The Getis Ord GI* technique was employed to assess spatial association, and the Kernel density estimator was used to identify areas with concentrated increases or decreases in outcomes. Bivariate Local Moran's I was used to examine the spatial association between outcomes and COVID-19 incidence. The study was approved by the Research Ethics Committee of Ribeirão Preto Nursing School, University of São Paulo.ResultsThere were 134,394 cases of loss to follow-up, 10,270 cases of drug resistance, and 37,863 deaths. Clusters of high and low values were identified for all three outcomes, indicating significant changes in the spatial distribution patterns. Increases in concentrations were observed for lost to follow-up cases in the Southeast, while reductions occurred in the Northeast, South, and Midwest. Drug-resistant tuberculosis experienced an increase in the Southern and Southeastern regions and a decrease in the Northeast and South. TB-related deaths showed notable concentrations in the Midwest, Northeast, South, and Southeast. There was an increase in high occurrence clusters for deaths after 2020 and 2021 in the Northeast.ConclusionsThe pandemic has brought additional challenges, emphasizing the importance of enhancing efforts and disease control strategies, prioritizing early identification, treatment adherence, and follow-up. This commitment is vital for achieving the goal of tuberculosis elimination.

Nutritional status and treatment outcomes of tuberculosis in Mizan Tepi University Teaching Hospital, a five -year retrospective study.

Public health problems related to tuberculosis (TB) remain substantial globally, particularly in resource-limited countries. Determining TB treatment outcomes and identifying contributing factors are the basic components of the TB control strategy. In Ethiopia, different studies have been done on treatment outcomes and multiple associated factors, and there is also a little information on the effect of nutritional status on TB treatment outcomes. So there is a need for comprehensive research that examines the combined effects of multiple factors along with nutritional status. A five-year institution-based retrospective cross-sectional study was conducted at Mizan Tepi University Teaching Hospital, South West Ethiopia. This study included all tuberculosis patients who were documented in the TB registration and had known treatment outcomes at the treatment facility between January 1, 2016, and December 31, 2020. Data was collected through a pretested structured data extraction checklist. Data were entered into Epidata version 3.1 and analyzed through SPSS version 22. Multiple logistic regression was employed to assess the association between dependent and independent variables. A p-value of less than 0.05 was considered statistically significant. Of the total 625 TB patients, 283 (45.3%), 175 (28%), and 167 (26.7%) had smear-positive, extra-pulmonary, and smear-negative tuberculosis, respectively. The majority of study participants had normal weight (62.2%), were in the age group of 15-44 (67.4%), were new cases (73.8%), and were from urban areas (69.4%). About 32.2% of cases were HIV-positive. The overall unsuccessful treatment rate was 25%. From the total unsuccessful treatment rates, the highest proportion was a death rate of 90 (14.4%), followed by a treatment failure of 56 (9%). Being female (AOR = 1.7, 95% CI: 1.2-2.5), HIV positive (AOR = 2.7, 95% CI: 1.9-4.1), undernutrition (BMI<18.5kg/m2) (AOR = 1.9, 95% CI: 1.3-2.9), and smear-negative pulmonary TB (AOR = 1.6, 95% CI: 1-2.5) were independent predictors of unsuccessful treatment outcomes. The treatment success rate in the study area is very poor. Poor treatment outcomes were associated with undernutrition, female gender, HIV positivity and smear-negative pulmonary TB. So, continuous and serious supervision and monitoring of directly observed treatment short course (DOTS) program accomplishment, early detection of HIV and TB, prompt anti TB and antiretroviral treatment initiation and adherence, enhanced nutritional assessment, and counseling services need to be strengthened to improve treatment outcomes.

Tuberculosis in elderly Australians: a 10-year retrospective review.

This report describes the epidemiology of active tuberculosis (TB) in elderly Australians (≥65 years) with analysis of the factors associated with TB disease and successful treatment outcomes. A retrospective study of TB cases reported to the National Notifiable Diseases Surveillance System over a 10-year period from 2011 to 2020 was conducted. Cases were stratified by sex, age, risk factors, drug resistance, treatment type and outcome. Notification rates and incidence rate ratios with 95% confidence intervals were calculated and factors associated with treatment success analysed using multivariable logistic regression. A total of 2231 TB cases among elderly people were reported over the study period, with a 10-year mean incidence rate of 6.2 per 100 000 population. The median age of cases was 75 years (range 65-100 years); most were male (65%) and born overseas (85%). Multivariable analysis found that successful treatment outcome was strongly associated with younger age, while unsuccessful treatment outcome was associated with being diagnosed within the first 2years of arrival in Australia, ever having resided in an aged-care facility and resistance to fluoroquinolones. Compared to other low-incidence settings in the Western Pacific Region, TB incidence in elderly people is low and stable in Australia, with most cases occurring among recent migrants from TB-endemic settings. Continued efforts to reduce TB importation and address migrant health, especially among elderly people, are important.

Impact of diabetes mellitus on tuberculosis treatment outcomes: a cohort study in Bengaluru, India

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in regions with a high prevalence of diabetes mellitus (DM). This study aims to evaluate the impact of DM on the treatment outcomes of TB patients in Bengaluru, India. Methods: In this cohort study, we examined 592 patients with smear-positive pulmonary TB, half of whom had a comorbid diagnosis of DM. Conducted in the Bruhat Bengaluru Mahanagara Palike area, the study included patients registered under the national TB elimination programme (NTEP). Data were collected on demographic characteristics, treatment adherence, sputum positivity, and treatment outcomes over six months. Results: The study revealed a high prevalence of DM among TB patients. Significant associations were observed between DM and various challenges, including higher rates of sputum positivity, poor adherence to anti-TB and anti-diabetic medications, increased adverse drug reactions (ADRs), and a higher default rate. TB patients with DM had a 1.5 times higher risk of unsuccessful treatment outcomes compared to non-diabetics. Furthermore, the risk of poor outcomes, particularly relapse, increased substantially in the TB-DM group during the six-month follow-up. Conclusions: Our findings highlight the crucial need for integrated TB and DM management strategies. This includes routine DM screening for TB patients, personalized treatment regimens, and enhanced patient education and support. These measures are essential for improving treatment outcomes in TB patients with comorbid DM.

Impacts of body weight change on treatment outcomes in patients with multidrug-resistant tuberculosis in Northwest Ethiopia

Measuring body weight during therapy has received insufficient attention in poor resource settings like Ethiopia. We aimed to investigate the association between weight change during therapy and treatment outcomes among patients with multidrug-resistant tuberculosis (MDR-TB) in northwest Ethiopia. This retrospective cohort study analysed data from patients with MDR-TB admitted between May 2015 to February 2022 at four treatment facilities in Northwest Ethiopia. We used the joint model (JM) to determine the association between weight change during therapy and treatment outcomes for patients with MDR-TB. A total of 419 patients with MDR-TB were included in the analysis. Of these, 265 (63.3%) were male, and 255 (60.9%) were undernourished. Weight increase over time was associated with a decrease in unsuccessful treatment outcomes (adjusted hazard ratio (AHR): 0.96, 95% CI: 0.94 to 0.98). In addition, patients with undernutrition (AHR: 1.72, 95% CI: 1.10 to 2.97), HIV (AHR:1.79, 95% CI: 1.04 to 3.06), and clinical complications such as pneumothorax (AHR: 1.66, 95% CI: 1.03 to 2.67) were associated with unsuccessful treatment outcomes. The JM showed a significant inverse association between weight gain and unsuccessful MDR-TB treatment outcomes. Therefore, weight gain may be used as a surrogate marker for good TB treatment response in Ethiopia.

Treatment Outcomes and Risk Factors Associated with Unsuccessful Treatment Outcomes among Extra Pulmonary Tuberculosis Patients

Background The World Health Organization report 2021 states that about 10.6 million people got tuberculosis, and 17.0% of them had extra-pulmonary tuberculosis. There is not much published research on extra-pulmonary tuberculosis in Pakistan. The objective of this study was to find out the success rate and the predictors for unsuccessful treatment outcomes of EPTB patients. Methods This study was retrospective cohort study, the study included 320 EPTB patients who were registered and treated at BMCH Quetta, Balochistan, from January 1, 2021 to June 30, 2021. SPSS version 21 was used to analyze the data, and a p-value 0.05 was used to determine statistical significance. Results The treatment had a success rate of 74.4% overall, with 12.4% of the patients LTFU, 5.6% died, and 2.4% failed the treatment. Age older than 60 years (OR = 10.440, p = 0.000) and having meningeal tuberculosis (OR = 3.506, p = 0.008) were found to be predictors for unsuccessful treatment outcomes. Conclusion The success rate of EPTB did not meet the End TB Strategy’s goal of &gt;90%, as set by the World Health Organization. Therefore, elderly patients and those with meningeal tuberculosis need special attention to improve treatment outcomes.

Prediction of pulmonary tuberculosis treatment outcome in a sub-Saharan African context.

Failure to treat many pathogens is a concern. Identifying a priori, patients with potential failure treatment outcome of a disease could allow measures to reduce the failure rate. The objectives of this study were to use the Scoring method to identify factors associated with the tuberculosis unsuccessful treatment outcome and to predict the treatment outcome. A total of 1,529 patients with pulmonary tuberculosis were randomly selected in the city of Douala, Cameroon, this sample was randomly split into two parts: one subsample of 1,200 patients (78%) used as the Development sample, and the remaining of 329 patients (22%) used as the Validation sample. Baseline characteristics associated with unsuccessful treatment outcomes were investigated using logistic regression. The optimal score was based on the Youden's index. HIV positive status, active smoker and non-belief in healing were the factors significantly associated with unsuccessful treatment outcomes (P#x003C;0.05). A model used to estimate the risk of unsuccessful treatment outcome was derived. The threshold probability which maximize the area under the ROC curve was 18%. Patients for whom the risk was greater than this threshold were classified as unsuccessful treatment outcome and the others as successful. HIV positive and active smoking status were associated with death; the non-belief in healing, youth and male gender associated with lost-to-follow-up, TB antecedent and not having TB contact associated with therapeutic treatment failure. To increase the tuberculosis treatment success rate, targeted follow-up could be taken during the treatment for TB patients with previous characteristics.

Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis

BackgroundBoth tuberculosis (TB) and diabetes mellitus (DM) are major public health problems threatening global health. TB patients with DM have a higher bacterial burden and affect the absorption and metabolism for anti-TB drugs. Drug-resistant TB (DR-TB) with DM make control TB more difficult.MethodsThis study was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. We searched PubMed, Excerpta Medica Database (EMBASE), Web of Science, ScienceDirect and Cochrance Library for literature published in English until July 2022. Papers were limited to those reporting the association between DM and treatment outcomes among DR-TB and multidrug-resistant TB (MDR-TB) patients. The strength of association was presented as odds ratios (ORs) and their 95% confidence intervals (CIs) using the fixed-effects or random-effects models. This study was registered with PROSPERO, number CRD: 42,022,350,214.ResultsA total of twenty-five studies involving 16,905 DR-TB participants were included in the meta-analysis, of which 10,124 (59.89%) participants were MDR-TB patients, and 1,952 (11.54%) had DM history. In DR-TB patients, the pooled OR was 1.56 (95% CI: 1.24–1.96) for unsuccessful outcomes, 0.64 (95% CI: 0.44–0.94) for cured treatment outcomes, 0.63 (95% CI: 0.46–0.86) for completed treatment outcomes, and 1.28 (95% CI: 1.03–1.58) for treatment failure. Among MDR-TB patients, the pooled OR was 1.57 (95% CI: 1.20–2.04) for unsuccessful treatment outcomes, 0.55 (95% CI: 0.35–0.87) for cured treatment outcomes, 0.66 (95% CI: 0.46–0.93) for treatment completed treatment outcomes and 1.37 (95% CI: 1.08–1.75) for treatment failure.ConclusionDM is a risk factor for adverse outcomes of DR-TB or MDR-TB patients. Controlling hyperglycemia may contribute to the favorite prognosis of TB. Our findings support the importance for diagnosing DM in DR-TB /MDR-TB, and it is needed to control glucose and therapeutic monitoring during the treatment of DR-TB /MDR-TB patients.

EFFICACY OF LAPROSCOPIC HELLER'S MYOTOMY IN THE TREATMENT OF ACHALASIA

In a retrospective study conducted from September 6, 2021, to September 6, 2022, at the Thoracic Surgery Department of Bakhtawar Amin Trust Hospital in Multan, the objective was to evaluate the impact of laparoscopic Heller's Myotomy on patients with achalasia. Additionally, the study sought to identify pre-operative factors that influence treatment outcomes. The methodology involved recording pre-operative patient data, including dysphagia scores, and conducting pre-operative manometry to diagnose achalasia. The diagnostic criteria included a non-relaxing lower esophageal sphincter (LES) and abnormal esophageal contractions. Post-operative changes in dysphagia scores (delta) were calculated, and a dysphagia score falling below a specified cutoff was considered an unsuccessful treatment outcome. The study's results revealed that the patients had an average age of 48.5 years, with a standard deviation of 1.6. After Heller myotomy, the average decrease in dysphagia scores was 7.2, with a standard deviation of 2.5. A change in score of ≥5 was indicative of successful treatment, leading to dysphagia relief in 69 out of 80 patients (86%). The sole pre-operative variable that significantly predicted successful dysphagia relief was the pre-operative LES pressure. The responder group displayed higher LES pressure than the non-responder group, with 41.5 mm Hg ± 12.1 and 22.9 mm Hg ± 7.1, respectively (P = 0.001). No significant correlation was observed between post-operative LES pressure and changes in dysphagia scores. In conclusion, Heller's myotomy demonstrated excellent efficacy in providing dysphagia relief for achalasia patients. Notably, a high pre-operative LES pressure was identified as a significant predictor of an excellent treatment outcome.

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 &amp;gt; 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 &amp;gt;70 years, unemployment, immunesuppression and any anti-TB drug resistance. Conclusions Surveillance data shows that Ireland fails to meet the WHO target of &amp;gt; 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.

Treatment outcome and associated factors among adult patients with pulmonary tuberculosis in selected health centers in Addis Ababa Ethiopia.

The success rate of pulmonary tuberculosis in developing countries is different than expected despite effective treatment. We evaluated treatment outcomes and associated factors of pulmonary tuberculosis patients. A retrospective cross-sectional study was employed among randomly selected health centers in Addis Ababa, Ethiopia. Patient records of adult pulmonary tuberculosis patients treated between January 1st, 2017, and December 31st, 2019 were reviewed. Convenient sampling technique was used to select the study participants. Statistical package for social sciences (SPSS), version 24-computer software was used for analysis. Participants' characteristics were descriptively described, and Bivariate, and multivariate logistic regression analysis were used to determine independent variables related to clinical outcomes. The significance level was determined at p-value < 0.05 and a 95% confidence level. Six hundred thirty-six patient records with a mean age of 37.49± 2.99 were reviewed. The overall treatment success rate was 84.9%. Absence of comorbid illness [AOR = 0.444; 95% CI:0.219-0.900], non-smoking [AOR = 0.35; 95% CI:0.194-0.645], and being HIV negative [AOR = 0.22; 95% CI: 0.106-0.460] were associated with successful treatment outcomes, whereas, not having treatment supporter [AOR = 15.68; 95% CI: 8.11-30.33] was associated with unsuccessful treatment outcome. Treatment success in this study was below the average target set by WHO. HIV positivity, co-morbidities, and smoking increased risk of treatment failure. Patient education about cessation may improve treatment success.

Predictive Factors Associated with Successful Response to Percutaneous Adhesiolysis in Chronic Lumbar Radicular Pain.

Percutaneous adhesiolysis (PEA) is of interest in the treatment of lumbar radicular pain. This study aimed to assess the effectiveness of PEA in patients with chronic lumbar radicular pain refractory to epidural steroid injections and to determine predictive factors, including demographic, clinical, and procedural data, to provide superior treatment efficacy. One hundred and ninety-three patients were reviewed. Successful treatment outcome was described as a 50% reduction in the visual analog scale score. Among the 193 patients, 109 (56.2%) exhibited a positive treatment response at 12 months. In multivariate logistic regression analysis, no depression (OR, 3.105; 95% CI, 1.127-8.547; p = 0.028), no spondylolisthesis (OR, 2.976; 95% CI, 1.246-7.092; p = 0.014), no previous lumbar surgery (OR, 2.242; 95% CI, 1.067-4.716; p = 0.033), mild foraminal stenosis (OR, 3.460; 95% CI, 1.436-8.333; p = 0.006), no opioid use (OR, 1.782; 95% CI, 0.854-3.717; p = 0.123), and baseline pain scores (OR, 0.787; 95% CI, 0.583-1.064; p = 0.120) were the predictive factors significantly associated with unsuccessful treatment outcome. PEA is a useful treatment option for patients with chronic lumbar radicular pain refractory to epidural steroid injections. A history of lumbar surgery, spondylolisthesis, depression, and severe foraminal stenosis could be associated with a poor prognosis.

Factors associated with unsuccessful treatment outcome for tuberculosis in previously treated patients in Cali, Colombia, during the period 2015-2019

Introduction. The success rates in the treatment of tuberculosis are suboptimal. Objective. To identify associated factors with the lack of success of antituberculosis treatment in patients with a tuberculosis treatment history. Materials and methods. We performed a retrospective, analytical, observational, and cohort study of patients reentering the Mycobacterium program in Cali, Colombia. We included patients over 15 years old with pulmonary tuberculosis between 2015 and 2019 and a history of tuberculosis treatment. Patients with drug-resistant tuberculosis were excluded. Results. A total of 605 patients with a treatment history were included, 60% due to unfinished treatment and 40% due to relapse. Compared to patients reentering due to relapse (ORa=2.34, CI=1.62-3.38), the independent variables associated with treatment failure at discharge were homelessness (ORa=2.45, CI=1.54-3.89), substance dependence (ORa=1.95, CI=1.24-3.05), tuberculosis/HIV coinfection (ORa=1.69, CI=1.00-2.86), diabetes (ORa=1.89, CI=1.29-2.77), and unfinished previous tuberculosis treatment due to follow-up loss, abandonment, or other causes. Programmatic variables favoring treatment success were voluntary HIV testing counseling (p<0.001) and HIV testing (p<0.001). Conclusion. Homelessness, substance dependence, tuberculosis/HIV coinfection, diabetes, and incomplete previous treatment due to loss to follow-up, abandonment, or treatment failure hindered the success of antituberculosis. These characteristics should be identified and addressed during the initial care of patients reentering treatment for tuberculosis.

A qualitative exploration of tuberculosis patients who were lost to follow-up in Malaysia.

Loss to follow-up (LTFU) is an unsuccessful treatment outcome for tuberculosis (TB) patients. In Malaysia, LTFU affects around 1 in 20 TB patients. Integration of qualitative research methods and evidence will provide a better understanding of LTFU and its underlying issues. In this study, we qualitatively explored TB patients' experiences in receiving treatment and their reasons for leaving TB care. In-depth interviews of 15 patients with a history of LTFU were conducted from January to September 2020. Interview guides were developed to explore TB patients' experiences while receiving treatment, including challenges faced and reasons for treatment interruption. Data were thematically analysed using the framework method. We identified 11 emerging themes that occurred at four levels of interaction with TB patients. First, at the patient personal level, TB beliefs referring to patients' perception of illness and wellness, patients' perceived role of traditional and complementary medicine, and substance abuse were important. Second, the healthcare system and treatment factors that were highlighted included the organisation of care and treatment, interaction with healthcare professionals, particularly in communication and counselling, and TB medications' side effects. Third, structural factors including financial burden, logistical and transportation issues and work-related factors were identified to be barriers to treatment continuation. Fourth, the interpersonal level interaction of patients should not be neglected; this includes family relationships and support as well as peer influence. Study findings put forth issues and challenges faced by TB patients while receiving treatment and underscore areas where actions can be taken. This will contribute to informing the development and implementation of future TB control strategies that are responsive to TB patients' needs and concerns, to effectively address LTFU and ensure better treatment completion rates among TB patients in Malaysia.