Evaluating treatment outcomes and durations among cases of smear-positive pulmonary tuberculosis in Yemen: a prospective follow-up study

Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis

BACKGROUND

Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically.

RESEARCH QUESTION

Is tobacco use associated with risk of poor treatment outcomes among people with TB?

STUDY DESIGN AND METHODS

The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively.

RESULTS

Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I2 = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I2 = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I2 = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I2 = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I2 = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it.

INTERPRETATION

Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes.

TRIAL REGISTRY

PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.

Sputum smear conversion and treatment outcomes among drug-resistant pulmonary tuberculosis patients in eastern Ethiopia: A 9-years data analysis

Background

Drug-resistant tuberculosis (DR-TB) has become a public health problem throughout the world and about one-third of deaths were attributed to DR-TB from antimicrobial resistance which contributes to 10% of all TB deaths. Sub-Saharan Africa, particularly Ethiopia accounts for a significant number of TB cases. However, the scanty evidence on DR-TB contributing factors could affect the level of this deadly case tackling program. Therefore, this study aimed to assess the factors affecting sputum smear conversion and treatment outcomes among patients with DR-TB in Health facilities in Eastern Ethiopia.

Methods and materials

A cross-sectional study design was employed from 10 October to 10 November 2021, in the health facilities providing DR-TB services in Harari Region and Dire Dawa city administration. The medical records of 273 DR-TB patients from 10 January 2013 to 27 December 2021, were reviewed using structured checklists. Data were entered into Epidata 3.1 version and exported to STATA 14 version for analysis. The outcome variables were Initial Sputum conversion (converted vs. not-converted) and treatment outcome (Unfavorable vs. Favorable). Sputum examination was performed using both Acid-fast bacillus (AFB) smear microscopy and Löwenstein–Jensen (LJ) culture technique. A binary logistic regression analysis was used to assess the association of independent variables with the first month sputum smear conversion, while a conditional logistic regression model was used to assess the association of treatment outcome with explanatory variables. The associations were reported using adjusted odds ratios (AORs) at a 95% confidence interval.

Results

A total of 273 DR-TB patients were included in this study. The unfavorable DR-TB treatment outcome was significantly associated with the history of chewing khat (AOR = 4.38, 95% CI = 1.62, 11.84), having bilateral lung cavity on baseline chest X-ray (AOR = 12.08, 95% CI = 1.80, 2.57), having greater than 2+ smear result at baseline (AOR = 3.79, 95% CI = 1.35, 10.59), and poor adherence (AOR = 2.9, 95% CI = 1.28, 6.82). The sputum smear non-conversion at first month was significantly associated with being Human Immune Virus (HIV)-negative (AOR = 0.37, 0.17, 0.82), having low baseline BMI (AOR = 0.54, 95% CI = 0.29, 0.97), baseline culture > 2++ (AOR = 0.15, 95% CI = 0.05, 0.49) and having greater than 2+ sputum smear result (AOR = 0.09, 95% CI = 0.012, 0.67). Patients with normal chest X-ray at baseline had 3.8 times higher chance of sputum smear conversion on first month (AOR = 3.77, 1.11, 12.77).

Conclusion

The overall initial sputum smear conversion and the treatment success rate among DR-TB patients were 52.75 and 66.30%, respectively. The Baseline underweight, HIV-negative, baseline smear > 2+, baseline culture > 2++, and clear lung on baseline X-ray were associated with smear conversion and history of khat chewing, bilateral lung cavity at baseline, having greater than 2+ smear results at baseline, and patients with poor treatment adherence had hostile treatment outcomes. So, strengthening and implementing nutrition assessment and patient counseling during directly observed therapies (DOTs) service and drug compliance could result in early sputum conversion and better treatment outcomes. DR-TB patients with high bacterial load and abnormal lungs on radiologic examination at baseline could need special attention during their course of treatment.

Associated Factors of the Results of Pulmonary Tuberculosis Treatment During the COVID-19 Pandemic in Makassar City

BACKGROUND: A regimen directly observed treatment-short course is recommended by the World Health Organization as a strategy for controlling tuberculosis (TB). AIM: This treatment was carried out for 6 months despite the COVID-19 pandemic situation. The purpose of the study was to determine the factors associated with the treatment outcomes of pulmonary TB undergoing treatment during the COVID-19 pandemic, with the research target was Category I pulmonary TB patients. METHOD: The type of research was observational analytic with a cohort study design. This research was conducted at the Pulmonary Center in October 2020-May 2021 involved 62 samples. RESULTS: About 75.8% (47 respondents) successfully treated and 24.2% (15 respondents) decided unsuccessful. There was a significant association between diabetes status (p = 0.014), anemia status (p = 0.035), knowledge of TB (p = 0.009), knowledge of COVID-19 (p = 0.014), and family history of COVID-19 exposure (p = 0.011) to the treatment outcomes of pulmonary TB treatment during the pandemic. CONCLUSION: Associated factors to the outcome of treatment for pulmonary TB patients undergoing TB treatment during a pandemic included diabetes mellitus status, anemia status, knowledge of TB, knowledge of COVID-19, and family history of exposure to COVID-19.

Substance use disorders and adherence to antituberculosis medications in Southwest Ethiopia: a prospective cohort study

OBJECTIVES

In Ethiopia, little is known about the association between substance use disorders and adherence to antituberculosis (anti-TB) medications. Therefore, the objective of this study was to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia.

DESIGN

Prospective cohort study.

SETTINGS

Patients were recruited from 22 health centres and four hospitals in Southwest Ethiopia.

PARTICIPANTS

This study was conducted among 268 patients with TB, aged 18-80 in Southwest Ethiopia between October 2017 and October 2018. At baseline, patients who were exposed substance use disorders (134 patients) and unexposed to substance use disorders (134 patients) were recruited. Patients were followed for 6 months, and data were collected on three occasions.

MAIN OUTCOME MEASURE

Adherence to anti-TB medications.

RESULTS

Patients with substance use disorders had consistently higher prevalence of non-adherence than those without, 16.4% versus 3.0% at baseline, 41.7% versus 14.4% at 2-month follow-up and 45.7% versus 10.8% at 6-month follow-up assessments. Patients with khat use disorder were 3.8 times more likely to be non-adherent to anti-TB medications than patients without khat use disorder (Adjusted odds ratio (aOR)=3.8, 95% CI 1.8 to 8.0). Patients who had alcohol use disorder (AUD) were also 3.2 times likely to have poor adherence compared with their counterparts (aOR=3.2, 95% CI 1.6 to 6.6). In addition, being educated (aOR=4.4, 95% CI 1.7 to 11.3), and being merchant (aOR=6.1, 95% CI 1.2 to 30.8) were associated with non-adherence to anti-TB medications.

CONCLUSION

Khat and AUDs predict greater likelihood of non-adherence to anti-TB medication. This implies the need to integrate the management for substance use disorders into the existing TB treatment services.

Magnitude and predictors of khat use among patients with tuberculosis in Southwest Ethiopia: A longitudinal study

INTRODUCTION

Tuberculosis (TB) is a leading cause of morbidity and mortality in low and middle-income countries. Substance use negatively affects TB treatment outcomes. Our recent study has found that khat use predicted poorer adherence to anti-TB medications. However, there is scarce longitudinal study on predictors of khat use among outpatients with TB, and this study aimed at addressing this research gap.

METHODS

From October 2017 to October 2018, 268 outpatients with tuberculosis on DOTs were enrolled in a longitudinal study from 26 health institutions in Southwest Ethiopia. Structured questionnaires translated into local languages (Afaan Oromoo and Amharic) were used to assess khat use. Patients were followed for six months, and data were collected on three occasions during the follow-up. A generalized linear mixed model was used to identify the relation between khat use and predictors. Model fitness was checked using the Bayesian Information Criterion (BIC). Odds ratio (OR) and 95% CI were used to describe the strength of association between the outcome variable and predictors.

RESULTS

The overall prevalence of khat use at baseline and first follow up was 39.2% while it was 37.3% at second follow up. Of this, 77.1% and 96.2% of them believed that khat use reduces the side effects of anti-TB medications and symptoms of tuberculosis respectively. In the final model, being male (aOR = 7.0, p-value = 0.001), being government employee (aOR = 0.03, p-value≤0.001) and presence of alcohol use disorders (AUD) (aOR = 2.0, p-value≤0.001) predicted khat use among outpatients with tuberculosis.

CONCLUSION

A considerable proportion of patients with TB used khat throughout DOTs and wrongly perceived that it had health benefits. The finding implies that all patients diagnosed with TB should be screened for khat use, and a particular emphasis should be given to males and individuals with a history of alcohol use. Moreover, further studies are needed to assess patients' beliefs regarding the benefits of khat use so that interventions can be developed.

Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis

OBJECTIVE

To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment.

METHODS

Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512.

RESULTS

A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated.

CONCLUSION

The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.

Health-related quality of life of patients with multidrug-resistant tuberculosis in Yemen: prospective study

BACKGROUND

Substantial efforts are currently focused on investigating and developing new multidrug-resistant tuberculosis (MDR-TB) drugs and diagnostic methods. In Yemen, however, the evaluation of health-related quality of life (HRQoL) and the effect of current MDR-TB treatment on the QoL are commonly ignored. This study evaluated the HRQoL during and after treatment and identified the risk factors that are predictive of HRQoL score differences.

METHOD

A prospective cohort study was conducted in four of the five main MDR-TB centres in Yemen. The patients confirmed with MDR-TB completed the SF-36 V2 survey at the beginning of treatment, end of treatment (continous phase) and at the 1 year follow-up after completing treatment. A total normal base score (NBS) of < 47 reflects impairment of functions, whereas a mental component summary (MCS) score of < 43 indicates a risk of depression.

RESULT

At the beginning of treatment, the mean scores for all health domains were < 47 NBS points (PF = 40.7, RP = 16.1, BP = 21.6, GH = 28.3, VT = 14.55, SF = 25.9, RE = 13.7, and MH = 14.7). At the completion of treatment, all eight health domains increase compare to beginning of treatment (PF = 59.3, RP = 31.1, BP = 40.9, GH = 48.5, VT = 30.5, SF = 46.6, RE =26.6 & MH = 27.7), but a follow-up duration of 1 year after completing treatment showed decreased NBS points in all domains (PF = 51.5, RP = 30.6, BP = 39.1, GH = 47.8, VT = 30.2, SF = 43.7, RE =26.4 & MH = 27.2). Age, history of streptomycin use, baseline lung cavity, marital status and length of sickness before MDR-TB diagnosis were predictive of in PCS score differences, whereas, age, smoking, baseline lung cavity, stigma, residence, marital status and length of sickness before MDR-TB diagnosis were predictive of MCS scores differences.

CONCLUSION

The length of sickness before DR-TB diagnosis was found to be predictive of the trends in both PCS and MCS scores. Despite the positive outcome of MDR-TB treatment, the low HRQoL scores obtained for all heath domains and especially for mental health reflect a high depression status of patients even after 1 year of completing therapy. Moreover, the poor HRQoL, particularly regarding mental health, of study participants at the end of treatment demands the need for urgent attention from national tuberculosis control programme managers. Therefore, the Yemen Ministry of Health and the National Tuberculosis Control Programme should implement an intervention programme to enhance HRQoL at the end of treatment to avoid any further negative consequences of MDRTB in patients after treatment. Moreover, The HRQoL data of patients with MDR-TB must be collected at the different stages of MDR-TB treatment to provide an additional parameter for assessing the effectiveness of the treatment programme.

TRIAL REGISTRATION

SNOYEM 1452. Registered 01 February 2013.

A retrospective analysis of treatment outcomes of drug-susceptible TB in Kazakhstan, 2013-2016

Kazakhstan has a high burden of multidrug-resistant tuberculosis (TB). The patient-centered National Program for the treatment and prevention of TB has been implemented in Kazakhstan. The program is aimed at meeting the needs of patients and expansion of the outpatient treatment of TB in the country.The aim of the study was to compare the efficacy of the outpatient and inpatient treatment of drug-susceptible TB.This study was a retrospective cohort study.A total of 36.926 TB cases were included. The majority of patients were treated as inpatients. The socioeconomic factors, sex, age, HIV status, and other diagnostic factors (e.g., sputum smear results, extrapulmonary disease) may serve as risk factors to estimate the likely TB treatment outcome. The outpatient treatment of drug-susceptible TB seems to be a comparable option to the inpatient treatment in terms of efficacy.The socioeconomic factors are the main modifiable risk factors for treatment failure. The outpatient treatment of drug-susceptible TB is safe and effective.

Evaluation of risk factors associated with drug-resistant tuberculosis in Yemen: data from centres with high drug resistance

Background

The World Health Organization (WHO) has reported that Yemen has a high burden of drug resistance and a worrying shortage of implemented diagnostic methods and drug treatment regimens. Therefore, in this study, we evaluated the risk factors associated with multidrug-resistant tuberculosis (MDR-TB) and explored the poor TB management in Yemen.

Methods

Between January 2014 and December 2016, we enrolled 135 patients with MDR-TB from drug resistance programmes at four major TB centres in Yemen for this prospective study. After exclusion of 20 patients, treatment outcomes were reported for 115 patients who attended a series of follow-ups.

Results

A total of 115 patients with MDR-TB were analysed from the four main TB centres in Yemen. Most patients (35.2%) were from the Aden TB centre. A success rate of 77.4% was reported for TB treatment. Of the 115 patients, 69.6% were resistant to two drugs, 18.3% were resistant to three drugs, and 12.2% were resistant to four drugs. During the intensive phase of treatment, 19 patients (16.5%) reported one or more adverse events. A multivariate logistic regression analysis revealed that a baseline body weight of ≤40 kg [p = 0.016; adjusted odds ratio (AOR) = 25.09], comorbidity (p = 0.049; AOR = 4.73), baseline lung cavities (p = 0.004; AOR = 15.32), and positive culture at the end of the intensive phase (p = 0.009; AOR = 8.83) were associated with the unsuccessful treatment outcomes in drug-resistant TB patients.

Conclusions

The success rate achieved after treatment was below the levels established by the WHO End TB Strategy (90%) and the United Nations Sustainable Development Goals (80%). Identification of risk factors associated with MDR-TB in Yemen is essential because it allows health workers to identify high-risk patients, especially in the absence of a second-line treatment or a laboratory diagnostic method. The Yemen National Tuberculosis Control Program should formulate new strategies for early detection of MDR-TB and invest in new programmes for MDR-TB management.

The impact of social support on the health-related quality of life of adult patients with tuberculosis in Harare, Zimbabwe: a cross-sectional survey

OBJECTIVE

Tuberculosis (TB) is the second prime cause of mortality in Sub-Saharan Africa and remains a major worldwide public health problem. Unfortunately, patients with TB are at risk of poor mental health. However, patients who receive an adequate amount of social support are likely to have improved health outcomes. The study was done to establish how social support influences the health-related quality of life (HRQoL) of patients with TB in Harare, Zimbabwe. Data were collected from 332 TB patients and were analysed through structural equation modelling.

RESULTS

The mean age of the participants was 40.1 (SD 12.5) years and most were; males (53%), married (57.8%), educated (97.3%), unemployed (40.7%), stayed with family (74.4%), and reported of less than average levels of income (51.5%). Patients received the most significant amount of social support from the family. Patients also presented with lower HRQoL as they considerably reported of pain, anxiety and depression. The final model accounted for 68.8% of the variance. Despite methodological limitations, the study findings suggest that social support optimises patients' HRQoL. Based on the patients' responses, it was noted that patients presented with lower mental health, therefore, there is a need to develop and implement patient wellness interventions.