Treatment outcomes of multi-drug resistant tuberculosis and associated factors among patients at Iganga and Mbale treatment centres - Uganda: A retrospective cohort study

  • Anti-microbial resistance
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Background:
In 2018, the Ministry of Health Uganda, reported an increase in MDR-TB patients from 600 in 2015 to 1900 in 2016. The emergence of multi-drug resistant tuberculosis (MDR-TB) threatens the existing efforts to eliminate tuberculosis due to the complex treatment thereof. Whilst treatment of MDR-TB is available, MDR-TB treatment outcomes and associated factors have not been well established. We aimed to describe the treatment outcomes, determine the factors associated with unsuccessful treatment outcomes and explore facilitators and barriers of treatment success of MDR-TB patients in Iganga and Mbale treatment centres, Uganda.
Methods:
We conducted a retrospective cohort analysis of data from medical records of MDR-TB patients at Iganga and Mbale treatment centres for the period June 2013 to May 2018. We complemented the data with qualitative interviews from selected health workers and former patients. The qualitative data were analysed using thematic analysis. We performed Modified Poisson regression and mortality risk differences to determine the associations between factors and the treatment outcomes of MDR-TB using Stata 13.
Results:
Of the 95 patients, 74 (77.9%) had successful outcomes (cured and treatment completed) and 21 (22.1%) had unsuccessful outcomes (died, lost to follow up and treatment failed). There were 62% males, 41% were between 30-44 years, 88% had history of tuberculosis treatment and 34% were HIV positive. Only HIV status was likely to be associated with unsuccessful outcomes at bivariate analysis CPR 3.35 (CI 1.4-8.09) and the mortality rate attributable to HIV infection was 60% for the five year period. Facilitators of treatment success included good communication and coordination mechanisms, availability of adherence enablers, self motivation and family support whereas barriers included delayed treatment initiation, alcohol consumption and stigma.
Conclusion
There was high treatment success of MDR-TB patients however the prevalence of unsuccessful outcomes particularly mortality was high and associated with HIV infection.
This indicates the need to emphasize and improve MDR-TB/HIV collaborative services in order to attain better treatment outcomes.

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