Response to anti-tuberculosis treatment by people over age 60 in Kampala, Uganda

Level of tuberculosis-related stigma and associated factors in Ugandan communities

Tuberculosis (TB) stigma remains a significant barrier to TB control efforts globally, especially in countries with a high TB burden. Studies about TB stigma done in Uganda so far have been limited in scope and focused on data collected health facilities. In this study we report TB related stigma at community level for the period 2021/2022. We used the 2021/22 Lot Quality Assurance Sampling (LQAS) data from a sample of 33,349 participants across 77 districts, to measure TB stigma determine factors associated. We included demographic characteristics, knowledge and participant perspectives as our study variables. Univariable and multivariate logistic regression analyses were performed to identify factors associated with TB stigma. TB stigma was assessed as a categorical variable (below or above the median) due to the skewness of the data when fitting the scores. The data set had equal proportions of males and females. The largest age group was 20-29 years old (38.47%). Most participants were married (62.94%) and had primary level education (65.80%). The TB stigma scores were assigned on a scale from 0 to 30, with an average score of 21.67 (±8.22) and a median score of 24 (19-28). Overall, 45.48% of participants had TB stigma scores above the median. Variations in TB stigma levels were observed across different districts. Factors associated with higher TB stigma included older age, higher education levels, urban residence, and TB knowledge. To reduce TB stigma and misinformation that can make an impact on TB response, community interventions should balance increasing awareness with minimizing fear. These interventions should be well-rounded and context-specific to address disparities within communities and bolster TB control efforts in the country.

Predictors of treatment delay among drug resistant tuberculosis patients in Uganda

BACKGROUND

Drug resistant tuberculosis (DR-TB) continues to be a significant global public health concern despite the availability of effective TB medicines. Equally, delayed DR-TB treatment initiation is associated with increased morbidity, amplified resistance, transmission risk and poor treatment outcomes. This study aimed to investigate treatment delays and identify predictors of delayed treatment initiation among DR-TB patients in Uganda.

METHOD

A retrospective study was conducted using routine DR-TB national case registration data between January 2012 and December 2019. Stata version 15 was used to run uni-variate analysis to describe patient characteristics using frequencies and percentages; bivariate analysis to identify significant differences in median times to treatment initiation; and logistic regression model was fitted, and adjusted odds ratio (AOR) with 95% confidence interval was used to identify factors associated with DR-TB treatment delay.

RESULTS

A total of 2,166 DR-TB patients were included in this study. The median treatment initiation delay was 10 days. Approximately 57% of DR-TB patients experienced delays in starting their treatment beyond the acceptable 7-day timeframe. Being diagnosed as RR-TB [AOR = 1.22; 95% CI: 1.08-1.37], and being a recurrent TB patient [AOR = 1.22; 95% CI: 1.01-1.47] were associated with treatment delays. Patients with previous history of 'lost to follow-up' (LTFU), failure and being diagnosed as Pre-XDR-TB were less inclined to delay DR-TB treatment.

CONCLUSION

Several DR-TB patients experienced treatment delay. The delay was significant among patients diagnosed as RR-TB and those with TB treatment history of recurrent TB. This highlights the need for heightened vigilance among healthcare workers when managing DR-TB patients with a history of past TB treatment and those diagnosed as RR-TB to minimize delays. Furthermore, future research should investigate a comprehensive list of variables influencing the timing of treatment initiation after diagnosis. An in-depth understanding of the effects of these factors can inform targeted interventions to optimize treatment strategies for improved DR-TB patient outcomes.

Tuberculosis in elderly population: A cross-sectional comparative study

BACKGROUND

Tuberculosis (TB) is a common but neglected infectious disease of global significance. It has a varied presentation in the elderly compared to adults. The present study was conceived to study the resemblances and differences shared in terms of clinical profile, comorbidities, and laboratory investigations by TB in adults and the elderly population.

METHODS

In this cross-sectional study, 68 adults and 72 elderly patients of both genders were enrolled. We collected information on demographics, comorbidities, clinical presentations, and laboratory investigations. The comparison of data between groups was done using the unpaired t-test for continuous variables and the Chi-square test for frequency distribution analysis.

RESULTS

The mean age of the adults and elderly population was 42.13 ± 10.7 years and 68.78 ± 7.62 years, respectively. The elderly TB group demonstrated loss of weight, appetite, the prevalence of comorbid conditions (coronary artery disease, hypertension, and malnutrition), bilateral, predominantly lower lobe, and diffuse involvement of lungs.

CONCLUSION

As the elderly population increases, nonspecific clinical manifestations or laboratory results in this population mandate awareness of these atypical features for effective management of TB in this group.

Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India

The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (<60 years) patients from South India. This study was part of a large ongoing cohort study under the RePORT India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included in this study. Pretested and standardized questionnaire and tools were used to collect data and were stored securely for the entire cohort. Required demographic, anthropometric and treatment related variables were extracted from this database and analyzed using Stata version 14.0. Prevalence of elderly TB was summarized as percentage with 95% confidence interval (CI). Generalized linear modelling was attempted to find the factors associated with elderly TB. A total of 1,259 eligible TB patients were included into this present study. Mean (SD) of the participants in the elderly and non-elderly group was 65.8 (6.2) and 40.2 (12.0) respectively. Prevalence of elderly TB was 15.6% (95%CI: 13.6%-17.6%) with nearly 71% belonging to 60-69 age category. Male sex, OBC caste, poor education, unemployment, marriage, alcohol consumption and unable to work as per Karnofsky score were found to be significantly associated with an increased prevalence of elderly TB. Unfavorable outcomes (12% vs 6.5%, p value: 0.018), including death (9.3% vs 3.4%, p value: 0.001) were significantly higher among the elderly group when compared to their non-elderly counterparts. The current TB programme should have strategies to maintain follow up with due attention to adverse effects, social support and outcomes. Additional research should focus on predictors for unfavorable outcomes among the elderly TB group and explore ways to handle the same. Rendering adequate social support from the health system side and family side would be a good start.

A four-year trend in pulmonary bacteriologically confirmed tuberculosis case detection in Kampala-Uganda

BACKGROUND

The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also known as infectious TB is important not only to monitor for resistance but also to check for severity, treatment response and limit its spread.

METHOD

A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done.

RESULTS

Of the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. Sputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert testing, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acid-fast bacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194 (p = 0.000). The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597(43%) to 890(40.6%) (p = 0.000) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015 (p = 0.000). The treatment success rate (TSR) for PBC TB patients improved from 69% in 2012 to 75.5% by end of 2015 (p = 0.001) with an improvement in cure rate from 52.3% to 62% (p = 0.000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% (p = 0.013).

CONCLUSION

The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may elucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many people a single PBC TB patient is likely to infect with TB before being diagnosed and treated.