Time to treatment initiation among patients treated For Drug-Resistant Tuberculosis (DR-TB) in Uganda

Abstract

The main aim of the study was to investigate the socio-demographic, clinical, and structural factors associated with the timing of treatment initiation following DR-TB diagnosis among patients enrolled on DR-TB treatment in Uganda. The study further estimated the mean and median time from DR-TB diagnosis to treatment initiation. We used secondary data from the Uganda National TB/Leprosy Program's national case registration database, with a sample size of 2,166 DR-TB patients who completed treatment and had a two-year follow-up period from January 2012 to December 2019. Life tables were used to track the progression while the Kaplan-Meier survival curves were used to estimate the mean and median time to treatment initiation. The discrete time-to-event multivariable model with logistic regression was used to examine the association between the time of diagnosis to treatment initiation and selected independent variables. The results show that 57% of the patients in the study experienced delays, beyond the acceptable 7 days in treatment initiation, with an overall median delay of 10 days. Defaulter patient with previous history of TB treatment were found to have 35% reduced odds in the timing of treatment initiation following diagnosis compared to new patients (p-value=0.0000, OR=0.6532). Regarding failure patients, the reduction in the odds was nearly 20% (p-value=0.0010, OR=0.8024). In contrast, relapse patients demonstrated increased odds (p-value =0.0340, OR=1.2222) of the timing to treatment initiation compared to new patients. Among the DR-TB diagnostic categories, it was observed that RR-TB patients had significantly increased odds (p-value=0.0020, OR=1.2091) of the timing to treatment initiation compared to MDR-TB patients. A similar trend in the increase of delaying the timing of treatment was observed with pre-XDR-TB patients compared to MDR-TB patients (p-value=0.0230, OR=0.4420). In conclusion, study findings suggest that TB programs need to prevent patients from becoming defaulters (lost to follow up) and treatment failures while on first line TB treatment since being a defaulter or treatment failure is significantly associated with delay in treatment initiation following DR-TB diagnosis. However, further research is needed to validate these findings in larger DR-TB patient sample size and in different settings using a more comprehensive list of factors affecting treatment delay.