Incidence and factors associated with late sputum culture conversion among multi-drug resistant tuberculosis patients on treatment at Mulago Hospital
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Introduction: Tuberculosis (TB) remains one of the most common causes of death from an infectious disease. Late sputum culture conversion of Multi-Drug Resistant Tuberculosis (MDR-TB) patients poses a risk for poor treatment outcomes. Objective: The study aimed to determine the incidence and factors associated with late sputum culture conversion among MDR- TB patients on treatment at the tuberculosis (TB) unit of Mulago National Referral Hospital. Methods: This was a retrospective cohort study in which medical records of MDR-TB patients who received care at Mulago National Referral Hospital tuberculosis unit between January 1st, 2012 to December 31st, 2018 were reviewed. Consecutive sampling was employed to select 255 participants. Demographic characteristics (age, sex, marital status, and district), clinical factors (drug regimen, weight, type of patient at start of treatment, bacteria load, adherence, side effects and HIV status, any other comorbidity, and social factors (alcoholism and smoking) were studied. STATA version 15 was used for analysis. Incidence was calculated as the ratio of MDR -TB patients with late sputum culture conversion result to the total number of participants in the study. Factors associated with late sputum culture conversion were evaluated using generalized linear model (GLM) with Poisson family and log link using robust standard errors to adjust for over inflated variances. Results: The incidence of late sputum culture conversion was 32% (95% CI 26.3- 37.8). increasing age in years (incidence rate ratio IRR 1.004, 95%CI 1.000 1.008, P value 0.044), increasing weight (IRR 0.995, 95% CI 0.991- 0.999, P value 0.020) and multi drug tuberculosis MDR-TB regimen 9-12 months (IRR 0.893, 95% CI 0.805- 0.989, P value 0.030) were the factors associated with late sputum culture conversion. Conclusion: The incidence of late sputum culture conversion among MDR-TB patients on treatment was high (32%), occurring in about three out of every ten patients. Increasing weight, increasing age and MDR-TB drug regimen 9-12 months were significantly associated with late sputum culture conversion. We recommend health workers to initiate all MDR-TB patients who are eligible on the 9-12 months regimen, isolate patients for a minimum of two months until they sputum culture convert to minimize community transmission and categorize patients into high-risk groups (elderly and underweight) with special targeted packages.