“…After full-text review, 2 studies were found to be eligible for the analysis and a further 4 studies were obtained through manual searching, institutional repository sites of Addis Ababa University and email contact from the primary investigator. Finally, 6 studies were found to be acceptable for our analysis [ 20 – 25 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Relatively high treatment success rate was reported in Meressa et al (78.6%) [ 25 ] followed by Tolera et al (65.9%) [ 24 ] and Alene et al (63.6%) [ 22 ]. On the other hand, a high proportion of patients with poor outcome was observed in Tolera et al (34.1%) [ 24 ], followed by Alene et al (25.6%) [ 22 ] and Baye et al (22.7%) [ 20 ].…”
Section: Resultsmentioning
confidence: 99%
“…On the other hand, a high proportion of patients with poor outcome was observed in Tolera et al (34.1%) [ 24 ], followed by Alene et al (25.6%) [ 22 ] and Baye et al (22.7%) [ 20 ].…”
BackgroundThe programmatic management of Multidrug-resistant tuberculosis (MDR-TB) is entirely based on a WHO recommended long-term, 18–24 month lasting treatment regimen. However, growing evidence shows that low treatment success rate and high rates of adverse events are associated with this regimen. Up to date, the MDR-TB treatment outcome is not sufficiently understood in Ethiopia. Therefore, this analysis aimed to determine the pooled estimates of successful (cure, completed, or both), and poor outcomes (death, failure, and lost to follow ups).MethodA systematic search was performed to identify eligible studies reporting MDR-TB treatment outcomes in Ethiopia. Relevant studies for our analysis were retrieved from PubMed database search, Google Scholar and institutional repository sites of Ethiopian universities up to March 15, 2018. The primary outcome was treatment success, referring to a composite of cure and treatment completion. A random effect model was used to calculate pooled estimates.ResultsSix studies reporting treatment outcome on the 1993 MDR-TB patients were included in this analysis. Of the cases, the 1288 and 442 patients had a successful and poor outcome, respectively. In the pooled analysis, treatment success was observed in 59.2% (95%CI, 48.1–70.4) of patients, while 23.3% (95%CI, 19.7–27.0%) of patients had a poor outcome. in sub-group analysis,46.1% (95%CI, 34.2–58.0) were cured, 12.8% (5.7–20.0) treatment completed, 14.3% (11.5–17.2) died, 7.5% (3.7–11.3) lost to follow up, and 1.6% (1.1–2.2%) experienced treatment failure. The 25.0% (14.6–35.5) patients whose treatment outcome was not assessed (on treatment or transfer-out).ConclusionThe result of this study highlight treatment success among MDR-TB is below acceptable range. To update the current treatment regimen, the levels of evidence need to be replicated through meticulous surveillance systems.Trial registrationStudy protocol registration: CRD42018090711.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3401-5) contains supplementary material, which is available to authorized users.
“…After full-text review, 2 studies were found to be eligible for the analysis and a further 4 studies were obtained through manual searching, institutional repository sites of Addis Ababa University and email contact from the primary investigator. Finally, 6 studies were found to be acceptable for our analysis [ 20 – 25 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Relatively high treatment success rate was reported in Meressa et al (78.6%) [ 25 ] followed by Tolera et al (65.9%) [ 24 ] and Alene et al (63.6%) [ 22 ]. On the other hand, a high proportion of patients with poor outcome was observed in Tolera et al (34.1%) [ 24 ], followed by Alene et al (25.6%) [ 22 ] and Baye et al (22.7%) [ 20 ].…”
Section: Resultsmentioning
confidence: 99%
“…On the other hand, a high proportion of patients with poor outcome was observed in Tolera et al (34.1%) [ 24 ], followed by Alene et al (25.6%) [ 22 ] and Baye et al (22.7%) [ 20 ].…”
BackgroundThe programmatic management of Multidrug-resistant tuberculosis (MDR-TB) is entirely based on a WHO recommended long-term, 18–24 month lasting treatment regimen. However, growing evidence shows that low treatment success rate and high rates of adverse events are associated with this regimen. Up to date, the MDR-TB treatment outcome is not sufficiently understood in Ethiopia. Therefore, this analysis aimed to determine the pooled estimates of successful (cure, completed, or both), and poor outcomes (death, failure, and lost to follow ups).MethodA systematic search was performed to identify eligible studies reporting MDR-TB treatment outcomes in Ethiopia. Relevant studies for our analysis were retrieved from PubMed database search, Google Scholar and institutional repository sites of Ethiopian universities up to March 15, 2018. The primary outcome was treatment success, referring to a composite of cure and treatment completion. A random effect model was used to calculate pooled estimates.ResultsSix studies reporting treatment outcome on the 1993 MDR-TB patients were included in this analysis. Of the cases, the 1288 and 442 patients had a successful and poor outcome, respectively. In the pooled analysis, treatment success was observed in 59.2% (95%CI, 48.1–70.4) of patients, while 23.3% (95%CI, 19.7–27.0%) of patients had a poor outcome. in sub-group analysis,46.1% (95%CI, 34.2–58.0) were cured, 12.8% (5.7–20.0) treatment completed, 14.3% (11.5–17.2) died, 7.5% (3.7–11.3) lost to follow up, and 1.6% (1.1–2.2%) experienced treatment failure. The 25.0% (14.6–35.5) patients whose treatment outcome was not assessed (on treatment or transfer-out).ConclusionThe result of this study highlight treatment success among MDR-TB is below acceptable range. To update the current treatment regimen, the levels of evidence need to be replicated through meticulous surveillance systems.Trial registrationStudy protocol registration: CRD42018090711.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3401-5) contains supplementary material, which is available to authorized users.
“…The costs of TIC in our study is lower than studies from South Africa and higher than studies from Brazil, Bangladesh, and Tanzania. The difference in cost might be due to variation in the country’s economic status, the implemented model of care, the cost component included in the studies such as indirect costs, and the model used to estimate the costs [ 4 ].…”
Section: Discussionmentioning
confidence: 99%
“…The first is Treatment Initiation Centers (TIC), where patients usually are diagnosed and start the therapy. The second one is Treatment Follow-up Centers (TFC), where we follow the MDR-TB patients until they complete the MDR-TB treatment [ 4 – 6 ].…”
Background In Ethiopia, MDR-TB has become a significant public health threat; therefore, the Ministry of Health introduced two treatment approaches for MDR-TB cases: treatment initiative center (TIC) and treatment follow-up center (TFC). TIC is where patients usually are diagnosed and start the treatment. At TFC, we follow MDR-TB patients until they completed the treatment. However, there is no evidence about the cost-effectiveness of the approaches. Therefore, this study aimed to analyze the cost-effectiveness of MDR-TB treatment in TIC and TFC. Methods In this study, we employed a full economic evaluation from a providers' perspective. We followed a hypothetical cohort of individuals from the age of 15 for a lifetime using a Markov model with five mutually exclusive health states. We used both primary and secondary data sources for the study. Ingredient-based costing approach was used. The costs include healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect). We use a human capital approach to estimate the indirect cost. The cost estimates were reported in the 2017 United States Dollar (US$), and effectiveness was measured using disability-adjusted life-years (DALYs) averted. Both costs and health benefits were discounted using a 3% discount rate. Both average and incremental cost-effectiveness ratios (ICER) were reported calculated. One-way and probabilistic sensitivity analyses were reported to determine the robustness of the estimates.
To assess poor treatment outcomes and their predictors among drug-resistant tuberculosis patients treated in Ethiopia. Methods: Data were searched from both electronic databases and other sources. From the whole search, 404 articles were reviewed and 17 articles that fulfilled the inclusion criteria were included in the analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed and Joanna Briggs Institute Critical Appraisal checklist was used for assessing the quality. Risk of bias was assessed using forest plot and Egger's regression test. Data were analyzed using STATA version 15 and Review Manager Software version 5.3. Results: The overall pooled proportion of poor treatment outcome and mortality was 17.86% and 15.13% respectively. The incidence density rate of poor treatment outcome and mortality was 10.41/1000 person-months and 9.28/1000 person-months respectively. Survival status and successful treatment outcomes were 76.97% and 63.82% respectively. HIV positivity, non-HIV comorbidities, clinical complications, extrapulmonary involvement, undernutrition, anemia, treatment delay, lower body weight, and older age were the predictors of poor treatment outcome.
Conclusion:Better survival and treatment success rates were noted in Ethiopia as compared to the global average. The majority of the poor treatment outcomes occurred within the intensive phase. Early initiation of anti-tuberculosis treatment would be important for successful treatment outcomes.
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