| الوصف: |
Background:Tuberculosis (TB) is one of the leading causes of deaths in Africa, monitoring its treatment outcome is essential to evaluate treatment effectiveness. In this study, we aimed to evaluate proportion of poor TB treatment outcome (PTO) and its determinants during six-months of treatment in Kilifi County, Kenya. Methods:This study was a retrospective analysis of data from the TB surveillance system (TIBU) in Kilifi County, Kenya from 2012 to 2019. The outcome of interest was PTO (lost-to-follow-up (LTFU), death, transferred out, treatment failure, drug resistance) or successful (cured or completed treatment) treatment. We performed time-stratified (at three months follow-up) survival regression analyses accounting for sub-county heterogeneity to determine factors associated with PTO.Results:We included 14706 TB patients, median (IQR) age 37 (28–50) years old and 8791 (60%) males. A total of 13389 (91%) were on first line anti-TB treatment (2RHZE/4RH), 4242 (29%) were HIV infected and 192 (1.3%) had other underlying medical conditions. During 6586 person-years of follow-up, 2408 (16%) patients had PTO: 1074 (45%) deaths, 776 (32%) LTFU, 415 (17%) transferred out, 103 (4.3%) treatment failure and 30 (1.3%) multidrug resistance. The proportion of poor outcome increased from 7.9% in 2012 peaking at 2018 (22.8%) and slightly declining to 20% in 2019 (trend test P=0.03). Over two-thirds 1734(72%), poor outcomes occurred within first three months of follow-up. In the first three months of starting TB treatment, HIV infection (aHR 1.72 (95% CI 1.28–2.30)) and year of starting treatment were positively associated with PTO. However, in the last three months of treatment, elderly age ≥50 years, a retreatment patient, HIV infection, other underlying medical conditions (aHR 2.24 (95%CI 1.41–3.54)) and year of starting treatment were positively associated with PTO while being a female (aHR 0.83 (95%CI 0.70–0.97)) was negatively associated with PTO.ConclusionsOver two-thirds of poor outcomes occur in the first three months of TB treatment, therefore greater efforts are needed during this phase. Intervention targeting the HIV infected and other underlying medical conditions, the elderly and retreated patients provide an opportunity to improve TB treatment outcome. |
