Treatment success and associated factors among patients with pulmonary tuberculosis attending Kampala Capital City Authority health facilities: A retrospective cohort study

Abstract

Introduction: TB treatment success remains low in Uganda, below the recommended WHO target with consequences of poor treatment outcome which include; an increase in the prevalence MDR-TB, increased treatment costs and death. Kampala Capital City Authority (KCCA) public health facilities are congested which might compromise the care given to pulmonary tuberculosis patients (PTB) patients that may affect the treatment success of PTB patients. However, there is scarce information regarding factors that are associated with treatment success among PTB patients in public health facilities in Kampala. General Objective: To determine the treatment success and associated factors among patients with pulmonary tuberculosis attending Kampala Capital City Authority public health facilities in Kampala between July 2019 and June 2020. Methods: This was a retrospective cohort study design that involved review of records for 772 PTB patients who were enrolled on TB treatment in five KCCA public health facilities with functional TB diagnosis and treatment units (DTUs) for the period from July 2019 to June 2020. Data on socio-demographic and clinical factors was abstracted from health facility TB registers (HMIS TB 009) where the outcome variable was treatment success. Data was entered in epidata and analyzed using STATA v14 software. A modified poison regression model with robust standard errors was used in analysis and risk ratios were reported. Results: Overall, results showed that, of the 772 TB cohort, treatment success was 87.2% (CI: 84.2%-89.1%), where PTB patients who cured accounted for 413 (53.5%) and those who completed treatment accounted for 260 (33.7%). The factors significantly associated with PTB treatment success were: being classified as a clinically diagnosed PTB patient (aRR= 0.8, CI: 0.53 - 0.94, P value =0.021) and having a positive HIV/AIDS status (aRR= 0.7, CI: 0.43 - 0.88, P value =0.006) reduced treatment success. Our results also indicted that having a community volunteer as a treatment supporter was significantly associated with increased treatment success (aRR= 1.2, CI: 1.06 - 3.28, P value =0.028). Conclusion: Over 80% of pulmonary tuberculosis patients in KCCA public health facilities achieve treatment success although this is still below the WHO target. Factors associated with TB treatment success include; being classified as a clinically diagnosed PTB patient, having a positive HIV/AIDS status as factors that reduce treatment success and having a community volunteer as a treatment supporter improves treatment success. Efforts such as consistent follow-ups should be encouraged among clinically diagnosed and HIV/AIDS positive PTB patients. Additionally, community volunteers should be empowered to support PTB patients in order to improve TB treatment success.