Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study

Abstract

Background Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda.Methods We constructed a retrospective cohort of patients with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we used the modified Poisson regression analysis to determine factors independently associated with treatment success and mortality.Results We retrieved 1,123 patient records. Of these, 477(42.5%) had a cure, 323 (28.0%) had treatment completion, 17(1.5%) had failed treatment, 81(7.2%) had died, 89(7.9%) were lost to follow-up, and 136(12.1%) had missing treatment outcome. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had an outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82-0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81-0.97), or male (aRR, 0.92; 95% CI, 0.87-0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95-6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74-4.92), year of enrollment into treatment from 2015 (aRR, 0.80; 95% CI, 0.66-0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13-0.50).Conclusions Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality is high. HIV infection and older age reduce the chance of successful treatment of tuberculosis, and increase risk of mortality. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success and reduce risk of mortality.