Treatment Outcomes and Predictors of Outcome in Multidrug Resistance Tuberculosis (MDR-TB) Cohort of Patients in Addis Ababa, Ethiopia

Abstract

Multidrug Resistance Tuberculosis (MDR-TB) is a major global public health crisis that needs great emphasis. Ethiopia is one of the 30 high TB, TB/HIV and drug resistant TB (DR-TB) burden countries globally and stands third among African countries. Treatment outcomes of MDR-TB are one of the essential performance indicators in evaluating the national TB control program. Such assessments however are limited at the facility and program level in Ethiopia. This study reported treatment outcomes and outcome predictors from a cohort of MDR-TB patients who were on WHO's longer treatment regimen at ALERT Hospital in Addis Ababa, Ethiopia. A retrospective assessment of patients’ records was made and data were collected for the period 2011-to 2016 using structured checklist. Data were double entered to Red Cap and exported to SPSS v20 for analysis. Descriptive statistics was computed to get summary results, bivariate and multivariate analysis was used to identify factors which affect the dependent variables. Therefore a total of 363 (53.7% males and 46.3% females) MDR-TB patients were included in the study. The mean age of the study participants was 29.6 years with the standard deviation of 11.2 years; the mean BMI was 18.5 with standard deviation of 3.0; and 78 (21.5%) were HIV positive. The most prevalent side effects were gastric disturbance which includes epigastric pain/discomfort, indigestion, bloating and nausea/vomiting (46.25%). Electrolyte abnormality occurred in (39.53%) of the patents. Among all assessed patients, 147 (40.5%) were cured, 132 (36.4%) completed their treatment, treatment failure occurred in three patients (0.8%), 46 (12.7%) patients died and 35 (9.6%) patients were lost to their follow-up. Overall, treatment success of 279 (76.9%) was observed in this cohort. Female and employed patients who can generate regular income had favorable treatment outcome with (AOR: 2.5; 95%CI: 1.4, 4.2), (AOR: 2.4; 95%CI: 1.4, 4.0) respectively Patients with HIV were 50% lower to have a favorable treatment outcome than HIV negative patients with (AOR: 0.5; 95%CI: 0.3, 0.9). So, it has been concluded that treatment success rate was generally encouraging. However, significant numbers of patients were lost to follow up and died. Thus, targeted interventions towards addressing factors that affected treatment outcome in MDR-TB patient management should be made. Strengthened follow up should also be in place to reduce number of lost to follow up and deaths in MDR-TB patients.