Treatment Outcomes of Multi-drug Resistant Tuberculosis and associated factors among patients at Iganga and Mbale treatment centres, Uganda: A retrospective cohort study.

Abstract

Introduction The emergence of multi-drug resistant tuberculosis (MDR-TB) threatens the existing efforts to eliminate tuberculosis. The study 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 drug resistance tuberculosis (DR-TB) treatment centres, Uganda. Methods The study was a retrospective cohort analysis of secondary data from Iganga and Mbale DR-TB treatment centres for the period of June 2013 to May 2018 (five years). Ninety five (95) medical records were reviewed for treatment outcomes and patient characteristics. This data was complemented by qualitative interviews, six key informant interviews and four in-depth interviews with purposively selected health workers and former patients. Quantitative data was analysed using Stata version 13. Modified Poisson regression and mortality risk differences were used to determine associations between factors and the treatment outcomes of MDR-TB. Qualitative data was audio-recorded, transcribed and analysed using thematic analysis. Results Of the 95 patients, 74 (77.9%) had a successful outcome i.e. 57(60%) cured, while 17 (17.9%) had their treatment completed. Unsuccessful outcomes were observed in 21 (22.1%) patients i.e. two (2.1%) treatment failed, five (5.3%) lost to follow up and 14 (14.7%) died. There were 62% males, 41% were between 30-44 years, 88% had a history of tuberculosis treatment, 34% were HIV positive and there were three health workers in the sample. Side effects were reported in 85% of the patients with arthralgia/joint pain, gastrointestinal disturbances, and appetite loss as the most common effects. The median number of months on treatment was 22 IQR (24-22). 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 in the study population was 60% over a five year period. Facilitators of treatment success included good communication and coordination of the various stakeholders, availability of adherence enablers, self motivation and family support whereas barriers included delayed treatment initiation, alcohol consumption and stigma. Conclusion In this study high treatment success of MDR-TB patients was observed compared to the global average of 55% albeit less than the national and global target of 90%. However the prevalence of unsuccessful treatment outcomes particularly mortality was high and was associated with HIV infection. Facilitators to treatment success included adherence enablers, family support, to mention but a few. The collaborative management of MDR-TB/HIV co-infected patients needs to be scaled up as well as addressing the barriers to treatment in order to achieve the recommended targets of MDR-TB treatment outcomes.