Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study

Tok, Peter Seah Keng; Liew, Su May; Wong, Li Ping; Razali, Asmah; Loganathan, Tharani; Chinna, Karuthan; Ismail, Nurhuda; Kadir, Naim Abdul

doi:10.1371/journal.pone.0231986

Cited by 40 publications

(59 citation statements)

References 23 publications

(38 reference statements)

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“…This means that, despite the high uptake of HIV testing in TB patients in Armenia, there is a probability of missed opportunities to link HIV co-infected cases to the appropriate care. In our study, about 80% of cases with "not tested" status of HIV and unsuccessful treatment outcome were LTFU, which is consistent with the existing literature [12,33]. One explanation would be that the patient's refusal for HIV test may influence the provider's interaction with the patient, which may cause the patient to feel pressure and interrupt the treatment or leave the program and non-consent for HIV test might be an indicator of overall poor adherence to TB treatment [11].…”

Section: Discussionsupporting

confidence: 92%

“…This study also has several limitations. We did not have data on TB patients' nationality and residency, which are a known factors influencing the TB treatment outcome [33,34]. Previous studies in Armenia indicated about 95% of the registered TB patients in Armenia are natives, holding Armenian citizenship [32], which means that effect of this variable in our adjusted estimates would be minimal.…”

Section: Discussionmentioning

confidence: 96%

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

Abrahamyan¹,

Hann

Akopian³

et al. 2021

J Infect Dev Ctries

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Introduction: 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). Methodology: A cohort study of TB patients using routine programmatic data from the national TB program of Armenia. Results: 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. Conclusions: 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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

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

Abrahamyan¹,

Hann

Akopian³

et al. 2021

J Infect Dev Ctries

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“…Previous studies conducted in Ethiopia and Pakistan excluded chest X-ray results due to the availability of variables in their NTP database [ 9 , 12 , 14 ]. Recent local studies found an association of chest X-ray findings with unfavourable outcomes; however, these studies were conducted among all age groups [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years

et al. 2020

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Background Tuberculosis (TB) among children remains a significant public health problem in many parts of the world. The objective of this study was to describe the characteristics of TB patients and to determine the predictors of treatment success among children in Malaysia. Methods Secondary data from MyTB version 2.1, a national database, were analysed using R version 3.6.1. Descriptive analysis and multivariable logistic regression were conducted to identify treatment success and its determinants. Results In total, 3630 cases of TB cases were registered among children in Malaysia between 2013 and 2017. The overall treatment success rate was 87.1% in 2013 and plateaued between 90.1 and 91.4% from 2014 to 2017. TB treatment success was positively associated with being a Malaysian citizen (aOR = 3.43; 95% CI = 2.47, 4.75), being a child with BCG scars (aOR = 1.93; 95% CI = 1.39, 2.68), and being in the older age group (aOR = 1.06; 95% CI = 1.03, 1.09). Having HIV co-infection (aOR = 0.31; 95% CI = 0.16, 0.63), undergoing treatment in public hospitals (aOR = 0.38; 95% CI =0.25, 0.58), having chest X-ray findings of advanced lesion (aOR = 0.48; 95% CI = 0.33, 0.69), having EPTB (aOR = 0.58; 95% CI = 0.41, 0.82) and having sputum-positive PTB (aOR = 0.58; 95% CI = 0.43, 0.79) were negatively associated with TB treatment success among children. Conclusions The overall success rate of treatment among children with TB in Malaysia has achieved the target of 90% since 2014 and remained plateaued until 2017. The socio-demographic characteristics of children, place of treatment, and TB disease profile were associated with the likelihood of TB treatment success among children. The treatment success rate can be increased by strengthening contact tracing activities and promoting early identification targeting the youngest children and non-Malaysian children.

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“…Conventionally, it has been proven that sociodemographic factors such as age [ 4 ], gender [ 5 ], race [ 6 ], educational level [ 7 ], employment [ 8 ], health care worker [ 9 ], income [ 10 ], residency [ 11 ], nationality [ 12 ], country of origin [ 13 ], and smoking status [ 14 ] have a role in TB cases. However, evidence described in the literature confirmed the importance of conducting a study to better understand how air quality and weather can influence the cases of TB.…”

Section: Introductionmentioning

confidence: 99%

Association of sociodemographic and environmental factors with spatial distribution of tuberculosis cases in Gombak, Selangor, Malaysia

et al. 2021

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Tuberculosis (TB) cases have increased drastically over the last two decades and it remains as one of the deadliest infectious diseases in Malaysia. This cross-sectional study aimed to establish the spatial distribution of TB cases and its association with the sociodemographic and environmental factors in the Gombak district. The sociodemographic data of 3325 TB cases such as age, gender, race, nationality, country of origin, educational level, employment status, health care worker status, income status, residency, and smoking status from 1st January 2013 to 31st December 2017 in Gombak district were collected from the MyTB web and Tuberculosis Information System (TBIS) database at the Gombak District Health Office and Rawang Health Clinic. Environmental data consisting of air pollution such as air quality index (AQI), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and particulate matter 10 (PM10,) were obtained from the Department of Environment Malaysia from 1st July 2012 to 31st December 2017; whereas weather data such as rainfall were obtained from the Department of Irrigation and Drainage Malaysia and relative humidity, temperature, wind speed, and atmospheric pressure were obtained from the Malaysia Meteorological Department in the same period. Global Moran’s I, kernel density estimation, Getis-Ord Gi* statistics, and heat maps were applied to identify the spatial pattern of TB cases. Ordinary least squares (OLS) and geographically weighted regression (GWR) models were used to determine the spatial association of sociodemographic and environmental factors with the TB cases. Spatial autocorrelation analysis indicated that the cases was clustered (p<0.05) over the five-year period and year 2016 and 2017 while random pattern (p>0.05) was observed from year 2013 to 2015. Kernel density estimation identified the high-density regions while Getis-Ord Gi* statistics observed hotspot locations, whereby consistently located in the southwestern part of the study area. This could be attributed to the overcrowding of inmates in the Sungai Buloh prison located there. Sociodemographic factors such as gender, nationality, employment status, health care worker status, income status, residency, and smoking status as well as; environmental factors such as AQI (lag 1), CO (lag 2), NO2 (lag 2), SO2 (lag 1), PM10 (lag 5), rainfall (lag 2), relative humidity (lag 4), temperature (lag 2), wind speed (lag 4), and atmospheric pressure (lag 6) were associated with TB cases (p<0.05). The GWR model based on the environmental factors i.e. GWR2 was the best model to determine the spatial distribution of TB cases based on the highest R2 value i.e. 0.98. The maps of estimated local coefficients in GWR models confirmed that the effects of sociodemographic and environmental factors on TB cases spatially varied. This study highlighted the importance of spatial analysis to identify areas with a high TB burden based on its associated factors, which further helps in improving targeted surveillance.

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Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study

Cited by 40 publications

References 23 publications

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

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

Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years

Association of sociodemographic and environmental factors with spatial distribution of tuberculosis cases in Gombak, Selangor, Malaysia

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