Characteristics and treatment outcomes of tuberculosis retreatment cases in three regional hospitals, Uganda

Nakanwagi-Mukwaya, A.; Reid, Anthony; Fujiwara, Paula I.; Mugabe, Frank; Kosgei, Rose J.; Tayler-Smith, K.; Kizito, Walter; Joloba, Moses

doi:10.5588/pha.12.0105

Cited by 15 publications

(14 citation statements)

References 10 publications

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“…The difference between treatment success in this study and that reported to WHO may be because we evaluated all retreatment cases registered and not only classical retreatment cases that are routinely evaluated. Nonetheless, the results support previous findings from a smaller study conducted in three RRHs in Uganda [ 2 ].…”

Section: Discussionsupporting

confidence: 91%

“…In Uganda, it is at the discretion of the clinician to decide the TB treatment regimen to use in the management of retreatment ‘others’. At the time of the study, routine culture and DST for retreatment cases had been rolled out to the study sites with varying levels of implementation [ 2 ].…”

Section: Methodsmentioning

confidence: 99%

“…Uganda has limited capacity to conduct culture and DST investigations in TB retreatment patients. A study conducted in three regional referral hospitals (RRHs) in Uganda showed that only 13 % of 114 registered relapse smear-positive or treatment after failure cases had their sputum samples sent to National TB Reference Laboratory for culture and DST [ 2 ]. Since 2002, Uganda has notified an increasing number of TB retreatment cases from 1500 to about 4000 cases per year [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Tuberculosis retreatment ‘others’ in comparison with classical retreatment cases; a retrospective cohort review

Nabukenya-Mudiope¹,

Kawuma²,

Brouwer³

et al. 2015

BMC Public Health

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BackgroundMany of the countries in sub-Saharan Africa are still largely dependent on microscopy as the mainstay for diagnosis of tuberculosis (TB) including patients with previous history of TB treatment. The available guidance in management of TB retreatment cases is focused on bacteriologically confirmed TB retreatment cases leaving out those classified as retreatment ‘others’. Retreatment ‘others’ refer to all TB cases who were previously treated but with unknown outcome of that previous treatment or who have returned to treatment with bacteriologically negative pulmonary or extra-pulmonary TB. This study was conducted in 11 regional referral hospitals (RRHs) serving high burden TB districts in Uganda to determine the profile and treatment success of TB retreatment ‘others’ in comparison with the classical retreatment cases.MethodsA retrospective cohort review of routinely collected National TB and Leprosy Program (NTLP) facility data from 1 January to 31 December 2010. This study uses the term classical retreatment cases to refer to a combined group of bacteriologically confirmed relapse, return after failure and return after loss to follow-up cases as a distinct group from retreatment ‘others’. Distribution of categorical characteristics were compared using Chi-squared test for difference between proportions. The log likelihood ratio test was used to assess the independent contribution of type of retreatment, human immunodeficiency virus (HIV) status, age group and sex to the models.ResultsOf the 6244 TB cases registered at the study sites, 733 (11.7 %) were retreatment cases. Retreatment ‘others’ constituted 45.5 % of retreatment cases. Co-infection with HIV was higher among retreatment ‘others’ (70.9 %) than classical retreatment cases (53.5 %). Treatment was successful in 410 (56.2 %) retreatment cases. Retreatment ‘others’ were associated with reduced odds of success (AOR = 0.44, 95 % CI 0.22,0.88) compared to classical cases. Lost to follow up was the commonest adverse outcome (38 % of adverse outcomes) in all retreatment cases. Type of retreatment case, HIV status, and age were independently associated with treatment success.ConclusionTB retreatment ‘others’ constitute a significant proportion of retreatment cases, with higher HIV prevalence and worse treatment success. There is need to review the diagnosis and management of retreatment ‘others’.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tuberculosis retreatment ‘others’ in comparison with classical retreatment cases; a retrospective cohort review

Nabukenya-Mudiope¹,

Kawuma²,

Brouwer³

et al. 2015

BMC Public Health

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“…In addition, epidemiological studies show varying rates of treatment success across TB programme. For instance, studies show TSR of 82.2%13 and 80%14 in South Africa; 90.1%15 and 86.8%16 in Ethiopia; 39%17 in Uganda; 70% in Zimbabwe18 and 57.7%19 in Nigeria.…”

Section: Introductionmentioning

confidence: 99%

Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis

et al. 2019

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ObjectivesTo summarise treatment success rate (TSR) among adult bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients in sub-Saharan Africa (SSA).DesignWe searched MEDLINE, EMBASE, Google Scholar and Web of Science electronic databases for eligible studies published in the decade between 1 July 2008 and 30 June 2018. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. We used random-effects model to pool TSR in Stata V.15, and presented results in a forest plot with 95% CIs and predictive intervals. We assessed heterogeneity with Cochrane’s (Q) test and quantified with I-squared values. We checked publication bias with funnel plots and Egger’s test. We performed subgroup, meta-regression, sensitivity and cumulative meta-analyses.SettingSSA.ParticipantsAdults 15 years and older, new and retreatment BC-PTB patients.OutcomesTSR measured as the proportion of smear-positive TB cases registered under directly observed therapy in a given year that successfully completed treatment, either with bacteriologic evidence of success (cured) or without (treatment completed).Results31 studies (2 cross-sectional, 1 case–control, 17 retrospective cohort, 6 prospective cohort and 5 randomised controlled trials) involving 18 194 participants were meta-analysed. 28 of the studies had good quality data. Egger’s test indicated no publication bias, rather small study effect. The pooled TSR was 76.2% (95% CI 72.5% to 79.8%; 95% prediction interval, 50.0% to 90.0%, I2statistics=96.9%). No single study influenced the meta-analytical results or conclusions. Between 2008 and 2018, a gradual but steady decline in TSR occurred in SSA but without statistically significant time trend variation (p=0.444). The optimum TSR of 90% was not achieved.ConclusionOver the past decade, TSR was heterogeneous and suboptimal in SSA, suggesting context and country-specific strategies are needed to end the TB epidemic.PROSPERO registration numberCRD42018099151.

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“…But in resource limited settings, this is not followed as a routine. Though rapid diagnostics like GeneXpert are gaining popularity in quick diagnosis of M. tuberculosis and rifampicin resistance, cost factor hinders the regular use of such newer methods [15].…”

Section: Challenges In Managing Previously Treated Tb Patientsmentioning

confidence: 99%

Treatment Outcomes among Patients Treated With Category II Antituberculosis Regimen: Short Review

G¹

2018

Mycobact Dis

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Tuberculosis (TB) is one of the leading causes of morbidity and mortality, especially in developing and underdeveloped nations. To add to the burden, drug resistant TB is on the rise and India is handling the dual burden of drug sensitive TB and resistant TB. Previously treated TB cases when compared to the newly diagnosed, have poor treatment success rates and nearly seven times higher incidence of multi drug resistant TB. Proper management of patients treated with Category-II anti-tuberculous treatment (ATT) can result in decrease in emergence of drug resistant bacilli and interruption of disease transmission. Very few studies have reported the treatment outcomes of re-treatment cases and the associated factors in the literature. Favourable outcome rates are highly variable among the failure, relapse and default subgroups. There are many challenges faced by the treating physicians in diagnosis, treatment and follow-up of the re-treatment cases. This review describes the outcomes of patients treated with Category-II ATT and the challenges in managing the previously treated cases successfully. Relapse type of retreatment cases had better success rates compared to other subgroups.

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Characteristics and treatment outcomes of tuberculosis retreatment cases in three regional hospitals, Uganda

Cited by 15 publications

References 10 publications

Tuberculosis retreatment ‘others’ in comparison with classical retreatment cases; a retrospective cohort review

Tuberculosis retreatment ‘others’ in comparison with classical retreatment cases; a retrospective cohort review

Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis

Treatment Outcomes among Patients Treated With Category II Antituberculosis Regimen: Short Review

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