Treatment outcomes of drug resistant tuberculosis patients with multiple poor prognostic indicators in Uganda: A countrywide 5-year retrospective study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Background: Comorbid conditions and adverse drug events are associated with poor treatment outcomes among
patients with drug resistant tuberculosis (DR – TB). This study aimed at determining the treatment outcomes of
DR – TB patients with poor prognostic indicators in Uganda.
Methods: We reviewed treatment records of DR – TB patients from 16 treatment sites in Uganda. Eligible patients
had confirmed DR – TB, a treatment outcome in 2014–2019 and at least one of 15 pre-defined poor prognostic
indicators at treatment initiation or during therapy. The pre-defined poor prognostic indicators were HIV co infection, diabetes, heart failure, malignancy, psychiatric illness/symptoms, severe anaemia, alcohol use, ciga rette smoking, low body mass index, elevated creatinine, hepatic dysfunction, hearing loss, resistance to fluo roquinolones and/or second-line aminoglycosides, previous exposure to second-line drugs (SLDs), and
pregnancy. Tuberculosis treatment outcomes were treatment success, mortality, loss to follow up, and treatment
failure as defined by the World Health Organisation. We used logistic and cox proportional hazards regression
analysis to determine predictors of treatment success and mortality, respectively.
Results: Of 1122 DR – TB patients, 709 (63.2%) were male and the median (interquartile range, IQR) age was
36.0 (28.0–45.0) years. A total of 925 (82.4%) had ≥2 poor prognostic indicators. Treatment success and
mortality occurred among 806 (71.8%) and 207 (18.4%) patients whereas treatment loss-to-follow-up and failure
were observed among 96 (8.6%) and 13 (1.2%) patients, respectively. Mild (OR: 0.57, 95% CI 0.39–0.84, p =
0.004), moderate (OR: 0.18, 95% CI 0.12–0.26, p < 0.001) and severe anaemia (OR: 0.09, 95% CI 0.05–0.17, p
< 0.001) and previous exposure to SLDs (OR: 0.19, 95% CI 0.08–0.48, p < 0.001) predicted lower odds of
treatment success while the number of poor prognostic indicators (HR: 1.62, 95% CI 1.30–2.01, p < 0.001), for
every additional poor prognostic indicator) predicted mortality.
Conclusion: Among DR – TB patients with multiple poor prognostic indicators, mortality was the most frequent
unsuccessful outcomes. Every additional poor prognostic indicator increased the risk of mortality while anaemia
and previous exposure to SLDs were associated with lower odds of treatment success. The management of
anaemia among DR – TB patients needs to be evaluated by prospective studies. DR – TB programs should also
optimise DR – TB treatment the first time it is initiated.
Description
Keywords
Drug resistant, Tuberculosis, Outcomes, Treatment success, MDR-TB, Poor prognostic indicator
Citation
Baluku, J. B., Nakazibwe, B., Naloka, J., Nabwana, M., Mwanja, S., Mulwana, R., ... & Worodria, W. (2021). Treatment outcomes of drug resistant tuberculosis patients with multiple poor prognostic indicators in Uganda: a countrywide 5-year retrospective study. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 23, 100221.