Tuberculosis treatment success and its determinants among healthcare workers with tuberculosis in Selangor: A retrospective cross-sectional study.

Abstract

Introduction: Tuberculosis (TB) remains a major occupational risk for healthcare workers (HCWs), who face higher exposure and potential challenges in achieving optimal treatment outcomes. Despite extensive national TB control strategies in Malaysia, evidence on treatment success and its determinants among HCWs is limited. This study aimed to determine the proportion of TB treatment success and identify associated factors among HCWs with active TB in Selangor from 2014 to 2023 using the National Tuberculosis Registry (NTBR) system.

Materials and methods: A retrospective cross-sectional study was conducted using registry data from NTBR involving all HCWs diagnosed with active TB and registered in Selangor between 2014 and 2023. Universal sampling was applied to include all eligible cases with complete data. Variables were extracted across sociodemographic, occupational, sociocultural, and clinical domains. TB treatment success was defined as "cured" or "treatment completed", while unsuccessful outcomes included death, treatment failure, and not evaluated. Data were cleaned, deidentified, and analysed using SPSS version 29. Simple logistic regression identified variables with p<0.25 for inclusion in multiple logistic regression Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported. Model diagnostics included the Hosmer- Lemeshow test, ROC (Receiver Operating Characteristic) analysis, multicollinearity checks, interaction terms, and Cook's distance.

Results: A total of 313 HCWs with active TB were included. The TB treatment success rate was 86.9%, with 51.5% cured and 48.5% completing treatment. In multivariable analysis, three factors remained significantly associated with treatment success. HCWs aged <34 years had higher odds of treatment success (AOR=5.071; 95% CI: 2.009-12.801). Conversely, doctors (AOR=0.024; 95% CI: 0.003-0.218) and supporting staff (AOR=0.366; 95% CI: 0.143-0.936) showed significantly lower success compared to paramedics. Advanced chest X-ray (CXR) findings demonstrated strong positive associations: moderate (AOR=14.686; 95% CI: 5.873 - 36.724) and far advanced disease (AOR=10.783; 95% CI: 1.909-60.904). Commonly reported risk factors such as HIV, diabetes, smoking, BCG (Bacillus Calmette-Guérin) status, and comorbidities were not significantly associated. Model performance was robust (ROC: 88.3%; Hosmer-Lemeshow p=0.858).

Conclusion: TB treatment is successful among HCWs in Selangor (86.9%), which is near to the WHO (World Health Organization) End TB Strategy. The odds of treatment success were much higher among younger HCWs, whereas doctors and other supporting staff reported had lower adjusted odds in comparison with paramedics. Moderate and far advanced CXR findings at diagnosis were independently associated with higher treatment success; however, this finding should be interpreted cautiously because of the small number of far advanced cases and the possibility of estimate instability and residual confounding. Conventional risk factors like human immunodeficiency virus infection, diabetes mellitus, smoking, and BCG status were found not associated significantly and may be due to the small subgroups and the nature of this registry data limitation. These conclusions indicate the fact that occupational role and clinical presentation are significant factors defining TB treatment outcomes among HCWs. Rolespecific and targeted adherence support enhanced psychosocial interventions, and better NTBR data coverage can further improve the outcome of treatment and support the TB control in the Malaysian healthcare labour force.