Assessment of Success Rate of Directly Observed Treatment Short-Course (DOTS) in Tuberculosis Patients of South India

Abstract

Objective: To assess the success rate of DOTS for tuberculosis patients and the secondary objective was to identify the factors associated with unsuccessful treatment outcome. Methods: A retrospective study was conducted to review the medical records of patients (n = 1113) registered at the Directly Observed Treatment Short-Course (DOTS) clinic of Government Infectious Disease (Govt. ID) Hospital, Guntur, India. Multivariate logistic regression model was used to determine the factors associated with the treatment success rate. Results: The overall mean success rate of TB patients was found to be 82.8%. Treatment success rate (TSR) was steadily increased across the years from 73.9% in 2015 to 84.3% in 2016 and 88.9% in 2017 while the death rate was steadily decreased from 11.2% in 2015 to 6.25% in 2016 and 4.33% in 2017. Risk factors significantly associated with unsuccessful treatment outcome were found to be HIV positive (P<0.001), smear negative (P<0.001), all retreatment cases (P<0.001), smoking (P=0.008), and alcoholism (P=0.019). Smear positive patients had lower death rate (3.9% vs. 10.1%; P < 0.001) and failure rate ((2.6% vs. 8.7%; P < 0.001) compared to smear negative patients. Patients tested HIV positive had seen significantly unfavorable outcomes in death rate (OR= 9.17,; P < 0.001) and treatment failure (OR=13.3, 95% CI= 7.31-24.17; P < 0.001). Conclusion: Implementing the DOTS strategy proved the satisfactory success rate in the South Indian hospital across three years. The unsuccessful treatment outcome was significantly associated with gender, HIV status, re-treatment, smear negative, smoking and alcoholism.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Unsuccessful treatment outcome and associated factors among smear-positive pulmonary tuberculosis patients in Kepong district, Kuala Lumpur, Malaysia

“…A study in Kelantan showed that HIV was strongly associated with unsuccessful treatment outcome [3]. Other studies also showed a similar finding [16][17][18]. HIV tends to weaken the immune system.…”

Barriers to engagement by people with active tuberculosis in the care cascade in India: a systematic review of two decades of quantitative research

“…Undernutrition-defined as weight <35kg [134] or baseline weight less than the median for the cohort [86]-was associated with increased adjusted risk of unfavorable outcomes. People with HIV, or with unknown HIV status, had higher adjusted risk of unfavorable outcomes, as compared to people without HIV in 3 studies [86,130,132]. Unknown diabetes status (versus not having diabetes) was also associated with unfavorable outcomes in 1 adjusted analysis [130].…”

“…Given numerous studies for this subgroup, we only describe findings from adjusted analyses; findings from unadjusted analyses are reported in Table D4 in S4 Appendix. With regard to patient-, family-, or society-related factors, male sex was associated with unfavorable outcomes in 8 adjusted analyses [43,44,86,[128][129][130][131][132] (Fig 19). In 7 adjusted analyses, older age was associated with unfavorable outcomes across a range of age thresholds [86,89,91,129,130,133,134].…”

“…Clinical factors associated with increased adjusted odds of unfavorable outcomes included sputum smear positive pulmonary TB (versus extrapulmonary or smear negative pulmonary TB) in 5 studies [129,131,132,136,137], previous TB treatment history (versus new patients) in 9…”

“…Unknown diabetes status (versus not having diabetes) was also associated with unfavorable outcomes in 1 adjusted analysis [130]. Alcohol use was associated with unfavorable outcomes in 5 adjusted analyses [43,86,104,132,134], as was any history of smoking in 1 adjusted analysis [132]. 9…”