Risk factors of unsuccessful tuberculosis treatment outcomes among tuberculosis patients in selected provinces of Zimbabwe, 2013

Abstract

Background: Zimbabwe remains one of the most tuberculosis (TB) burdened countries globally especially in Matebeleland province despite evidence-based treatment interventions. Factors associated with unsuccessful TB treatment outcomes are not fully understood therefore the aim of this study was to examine the prevalence and factors associated with unsuccessful TB treatment outcome of patients who started TB treatment between January and December 2013 in selected Southern Provinces of Zimbabwe.

Methods: This cross-sectional study used secondary data from medical records of 1971 of TB patients who started TB treatment between 1 January and 31 December 2013 from Bulawayo, Matebeleland North and Matebeleland South provinces. The outcome variable and main exposures were obtained from TB registers. Descriptive analyses were used to ascertain the prevalence of unsuccessful TB treatment outcomes. Multivariable logistic regression was used to identify factors associated with unsuccessful TB treatment outcome while adjusting for potential confounders.

Results: The study sample comprised of 1968 TB patients with 45.3% females who had the outcome data. The prevalence of unsuccessful TB outcome was found to be 551 (28.0 %) (CI: 26.0; 30.0) with 430 (78.0%) deaths, 77 (14.0 %) lost to follow up, 31 (5.7%) treatment failures and 13 (2.4%) not evaluated. The odds of having an unsuccessful TB outcome among retreatment cases was 1.63 (AOR: 1.63; CI: 1.21 ;2.21). HIV positive patients were 1.82 times (AOR: 1.82; CI: 1.39; 2.41) more likely to have unsuccessful TB treatment than those who were HIV negative. Other factors such as age (AOR: 1.01; CI: 1.00; 1.02), accessing TB treatment at a polyclinic (AOR: 0.53; CI: 0.38; 0.77), ART use (AOR: 0.08; CI: 0.05; 1.35), and CD4 count less than between 351-500 cells/mm3 (AOR: 0.20; CI: 0.04; 0.91) were associated with unsuccessful TB treatment outcome.

Conclusion: Death and lost to follow up were the most prevalent adverse treatment outcome. Factors such as age, HIV status, facility where treatment was accessed, Tb classification, ART use and timing were found to be associated with unsuccessful TB treatment. TB programs should intensify follow up of TB patients to ensure adherence and completion of treatment, especially HIV coinfected patients to avoid adverse treatment outcomes such as death and defaulters.