Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis

Torres, Ninfa Marlen Chaves; Rodríguez, Jecxy Julieth Quijano; Andrade, Pablo Sebastián Porras; Arriaga, María B.; Netto, Eduardo Martins

doi:10.1371/journal.pone.0226507

Cited by 83 publications

(67 citation statements)

References 151 publications

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“…HIV negative patients in this study have lower odds of successful TB treatment outcomes. The findings were similar to those from Nigeria and elsewhere [ 43 – 47 ]. Although 88% of patients in our study were tested for HIV, about 20% of TB/HIV co-infected patients were not on ART which might explain the non-significant association of successful outcome with ART status among TB/HIV co-infected patients.…”

Section: Discussionsupporting

confidence: 89%

Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria

et al. 2021

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Background The Lagos State Tuberculosis, Buruli Ulcer, and Leprosy Control Program (LSTBLCP) started engaging private hospitals under the Public-Private Mix (PPM) Program in 2008. The study aimed to evaluate the trend and predictors of successful Tuberculosis (TB) treatment outcomes of patients managed across these private health facilities between 2010–2016 in Lagos, Nigeria. Methods Retrospective review of TB treatment register and treatment cards of patients commenced on TB treatment between January 2010 and December 2016 in 36 private health facilities engaged by the LSTBLCP. Between December 2016 and February 2017, data were collected and entered into Microsoft Excel by trained data entry clerks. The analysis was done using SPSS software. Independent predictors of successful treatment outcomes were determined using multivariate analysis at the statistical significance of p<0.05 and 95% confidence interval. Results A total of 1660 records of TB patients were reviewed. 1535 (92.47%) commenced treatment, while 1337 (87.10%) of all records had documented treatment outcomes. Of the 1337 patients with outcomes, 1044 (78.09%) had a successful treatment outcome, and 293 (21.91%) had an unsuccessful outcome. Majority were male, 980 (59.04%), Human Immunodeficiency Virus (HIV) negative status, 1295 (80.24%), diagnosed with smear, 1141 (73.14%), treated in private not-for-profit (PNFP) hospital, 1097 (66.08%), treated for TB between 2014–2016 (18.96%-19.52%). In multivariate analysis, age>20years (aOR = 0.26, p = 0.001), receiving TB treatment in 2013 (aOR = 0.39, p = 0.001), having genexpert for TB diagnosis (aOR = 0.26, p = 0.031) and being HIV positive (aOR = 0.37, p = 0.001) significantly reduced likelihood of successful treatment outcome. The site of TB, being on ART or CPT, were confounding determinants of successful treatment outcomes as they became non-significant at the multivariate analysis level. Conclusion Treatment outcome among Lagos private hospitals was low compared with NTBLCP and World Health Organization (WHO) target. We urge the government and TB stakeholders to strengthen the PPM interventions to improve adherence, particularly among People Living with HIV (PLHIV) and older TB patients. Hence, promotion of early care-seeking, improving diagnostic and case holding efficiencies of health facilities, and TB/HIV collaborative interventions can reduce the risk of an unsuccessful outcome.

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Section: Discussionsupporting

confidence: 89%

Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria

et al. 2021

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“…TB and HIV are public health problems that have a synergistic effect on each other, leading to a higher risk of unfavorable treatment results [46]. We corroborate this finding, although we understand that these risks are not randomly distributed among men and women.…”

Section: Discussionsupporting

confidence: 79%

Survival time among patients who were diagnosed with tuberculosis, the precocious deaths and associated factors in southern Brazil

et al. 2021

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Background A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil. Methods We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient’s diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox’s regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value <0.05 as statistically significant for all statistics applied. Results One hundred forty-six patients were included in the survival analysis, observing a median survival time of 23.5 days. We observed that alcoholism (HR=1.55, 95% CI=1.04-2.30) and being male (HR=6.49, 95% CI=1.03-2.68) were associated with death. The chance of precocious death within 60 days was 10.48 times greater than the chance of early death within 30 days. Conclusion Most of the deaths occurred within 2 months after the diagnosis, during the intensive phase of the treatment. The use of alcohol and gender were associated with death, revealing inequality between men and women. This study advanced knowledge regarding the vulnerability associated with mortality. These findings must be addressed to fill a gap in the care cascades for active TB and ensure equity in health.

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“…HIV-coinfection is a widely known risk factor for TB development since the risk for TB development is 19 times higher in the population living with HIV when compared with the rest of the population, leading to poorer outcomes and lower relapse-free cure rates 1 , 23 . Nonetheless, alcohol abuse or unhealthy alcohol usage is an increasingly acknowledged risk factor known to affect the outcome of TB treatment and a risk factor for TB treatment adherence 24 , 25 . Recent data obtained in Uganda and Kenya further demonstrate that alcohol use among HIV-infected individuals appears to be associated with decreased viral suppression due to the lower diagnosis rate and lower likelihood of being on an anti-retroviral treatment regimen if already HIV diagnosed 26 .…”

Section: Discussionmentioning

confidence: 99%

Genomic epidemiology of Mycobacterium tuberculosis in Santa Catarina, Southern Brazil

Verza

Scheffer

Salvato

et al. 2020

Sci Rep

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Mycobacterium tuberculosis (M.tb), the pathogen responsible for tuberculosis (TB) poses as the major cause of death among infectious diseases. The knowledge about the molecular diversity of M.tb enables the implementation of more effective surveillance and control measures and, nowadays, Whole Genome Sequencing (WGS) holds the potential to produce high-resolution epidemiological data in a high-throughput manner. Florianópolis, the state capital of Santa Catarina (SC) in south Brazil, shows a high TB incidence (46.0/100,000). Here we carried out a WGS-based evaluation of the M.tb strain diversity, drug-resistance and ongoing transmission in the capital metropolitan region. Resistance to isoniazid, rifampicin, streptomycin was identified respectively in 4.0% (n = 6), 2.0% (n = 3) and 1.3% (n = 2) of the 151 studied strains by WGS. Besides, resistance to pyrazinamide and ethambutol was detected in 0.7% (n = 1) and reistance to ethionamide and fluoroquinolone (FQ) in 1.3% (n = 2), while a single (0.7%) multidrug-resistant (MDR) strain was identified. SNP-based typing classified all isolates into M.tb Lineage 4, with high proportion of sublineages LAM (60.3%), T (16.4%) and Haarlem (7.9%). The average core-genome distance between isolates was 420.3 SNPs, with 43.7% of all isolates grouped across 22 genomic clusters thereby showing the presence of important ongoing TB transmission events. Most clusters were geographically distributed across the study setting which highlights the need for an urgent interruption of these large transmission chains. The data conveyed by this study shows the presence of important and uncontrolled TB transmission in the metropolitan area and provides precise data to support TB control measures in this region.

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Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis

Cited by 83 publications

References 151 publications

Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria

Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria

Survival time among patients who were diagnosed with tuberculosis, the precocious deaths and associated factors in southern Brazil

Genomic epidemiology of Mycobacterium tuberculosis in Santa Catarina, Southern Brazil

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