Tuberculosis treatment success among rural and urban Ugandans living with HIV: a retrospective study

Musaazi, Joseph; Kiragga, Agnes; Castelnuovo, Barbara; Kambugu, Andrew; Bradley, John; Rehman, Andrea M.

doi:10.5588/pha.16.0115

Cited by 21 publications

(26 citation statements)

References 16 publications

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“…The risk of death was higher in rural areas than urban areas. Generally, patients in rural areas have worse TB treatment outcomes than patients in the urban areas including LTFU [10, 17]. Our study presents data on recurrent TB and provides a valid assessment of recurrent TB treatment outcomes presented separately for death, treatment failure and LTFU.…”

Section: Discussionmentioning

confidence: 99%

Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

et al. 2019

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BackgroundAt least 13–20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurrent TB between different geographical settings.The objective of our study was to estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings.MethodsIn a retrospective cohort study conducted in southern province of Zambia, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Data was abstracted from the facility TB registers.ResultsOverall 3566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1).ConclusionRecurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting where heightened TB control activities are focused on areas with poor treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

et al. 2019

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“…Generally, patients in rural areas have worse TB treatment outcomes than patients in the urban areas including LTFU. [10,16] Our study presents data on recurrent TB and provides a valid assessment of recurrent TB treatment outcomes presented separately for death, treatment failure and LTFU. For recurrent TB patients understating the magnitude of LTFU is critical because recurrent TB patients who are LTFU are likely to progress to MDR-TB and are a potential risk to further transmission of the multi-drug resistant M. tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

Mutembo

Mutanga

Musokotwane³

et al. 2019

Preprint

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Background At least 13 -20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurrent TB between different geographical settings. The objective of our study was to estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings. Methods In a retrospective cohort study conducted in southern province of Zambia, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Data was abstracted from the facility TB registers. Results Overall 3,566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had

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“…Generally, patients in rural areas have worse TB treatment outcomes than patients in the urban areas including LTFU. [10,16] The strength of this study is that it describes recurrent TB cases from a large cohort of TB cases at multiple rural and urban sites in a setting with high prevalence of both TB and HIV. Additionally, the paper highlight some of the gaps in the program and clinical case management of recurrent TB.…”

Section: Discussionmentioning

confidence: 99%

Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

Mutembo

Mutanga

Musokotwane³

et al. 2019

Preprint

View full text Add to dashboard Cite

Setting Southern province, Zambia. Background At least 13 – 20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). Objective To estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings. Methods In a retrospective cohort study, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Results Overall 3,566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1). Conclusion Recurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting.

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Tuberculosis treatment success among rural and urban Ugandans living with HIV: a retrospective study

Cited by 21 publications

References 16 publications

Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

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