FACTORS ASSOCIATED WITH TREATMENT OUTCOMES AMONG NEW SMEAR-POSITIVE AND RETREATMENT TUBERCULOSIS PATIENTS IN ILORIN, KWARA STATE

Abstract

Background: Tuberculosis (TB) annually causes ill-health among millions globally and is ranked as the second leading cause of death after the HIV/AIDS infection. However, TB is highly curable when diagnosed and treated promptly. Unlike treatment regimens for new TB patients, the currently recommended regimen for re-treatment TB patients has never been evaluated for efficacy in randomized clinical trials or prospective cohort studies (Agarwala A. et al., 2014). This study aims at assessing the treatment outcomes among new smear-positive and re-treatment TB patients and factors associated with treatment outcome. Methodology: This is an analysis of retrospective data obtained from the register of the TB control program which contains records of all 831 TB (new smear-positive (NSP) and re-treatment) patients treated and with complete documentation in Ilorin within 2011-2013. Data containing age, sex, place of residence, year of enrollment, LGA where treatment was received and treatment outcomes was obtained. Treatment outcomes were categorized according to WHO/IUATLD guidelines into cured, completed, failed, died, default and transferred in, which were then grouped into good (cured and completed) or poor treatment outcome. Treatment outcomes among TB patients was used as the dependent variable while the independent variables were age, sex, place of residence, year of enrollment e.t.c. Descriptive Statistics, chi square test, Binary logistic regression and Kaplan Meier survival analysis were performed on the data with SPSS version 20. Results: The mean age of TB patients was 35.7 ±15.1 years. Out of all patients, 86.3% were new smear-positive patients and were place on Category I regimen while 13.7% were re-treatment patients on Category II regimen. Good treatment outcome was observed in 85.3% patients. Sputum conversion as at the end of the Intensive phase (IP) among NSP was 73.2% and 65.9% among re-treatment patients. Good outcome among NSP and re-treatment were 85.2% and 86.0% respectively. LGA (p=0.003) where treatment was received and year of enrollment (p=0.000) were associated with poor treatment outcome among NSP while none of the variables showed a significant association with treatment outcome among re-treatment patients. Patients treated in Ilorin East were 2 times more likely to have poor treatment outcome than those who were treated in Ilorin West LGA (OR = 2.0, 95% C.I = 1.1-3.7). Also, patients in age group 30-39 years were about 2 times more likely to have poor outcome than those in age group 50 years and above (OR = 2.6, 95% C.I = 1.4-4.8). The median sputum conversion time among NSP was 2 months and 3 months among re-treatment patients. Conclusion: The success rate among patients on both Categories I treatment and II treatment was satisfactory but with higher rate of death and failure among patients on category II treatment. This shows that the chances of a favourable treatment outcome were significantly less in Category II compared to Category I. This calls for enhanced monitoring of patients to ensure that NSP complete treatment to avoid being re-treated.