Characteristics of participants with successful treatment outcome
We retrieved 1,123 records, present and compare the characteristics of participants with and without successful treatment of tuberculosis and the results are shown in Table 1. Participants who were successfully treated were on average younger than those who were not successfully treated: 37.89 (SD = 15.15) years versus 41.20 (SD = 15.70), p = 0.008. Most of the successfully treated participants were males (510 (63.7%)), aged 15 to 34 years (387 (48.4%)), and new tuberculosis cases (708 (88.5%)). Participant characteristics namely sex, age, and HIV status differed between those successful treated and those unsuccessfully treated.
Table 1
Baseline characteristics of successfully and unsuccessfully treated participants
| | Tuberculosis treatment outcome | |
Characteristics | Level | Unsuccessful (No. (%)) | Successful (No. (%)) | P-value |
All participants | | 187 (18.9) | 800 (81.1) | |
District | Soroti | 104 (55.6) | 359 (44.9) | < 0.001 |
| Kumi | 49 (26.2) | 179 (22.4) | |
| Ngora | 26 (13.9) | 115 (14.4) | |
| Serere | 8 (4.3) | 147 (18.4) | |
Level of health facility | Health Center IV | 67 (35.8) | 341 (42.6) | 0.221 |
| General Hospital | 40 (21.4) | 161 (20.1) | |
| Referral Hospital | 80 (42.8) | 298 (37.2) | |
Location of health facility | Rural | 45 (24.1) | 230 (28.7) | 0.232 |
| Urban | 142 (75.9) | 570 (71.2) | |
Type of health facility ownership | Public | 173 (92.5) | 707 (88.4) | 0.132 |
| Private not-for-profit | 14 (7.5) | 93 (11.6) | |
Year of tuberculosis treatment | 2015 | 69 (36.9) | 298 (37.2) | 0.322 |
| 2016 | 45 (24.1) | 172 (21.5) | |
| 2017 | 47 (25.1) | 176 (22.0) | |
| 2018 | 26 (13.9) | 154 (19.2) | |
Sex | Female | 46 (24.6) | 290 (36.2) | 0.003 |
| Male | 141 (75.4) | 510 (63.7) | |
Age category | 15–34 | 73 (39.0) | 387 (48.4) | 0.037 |
| 35–50 | 66 (35.3) | 262 (32.8) | |
| More than 50 | 48 (25.7) | 151 (18.9) | |
Age (mean (SD)) | | 41.20 (15.70) | 37.89 (15.15) | 0.008 |
Type of patient | New | 154 (82.4) | 708 (88.5) | 0.031 |
| Previously treated | 33 (17.6) | 92 (11.5) | |
Pre-therapy bacilli | 1+ | 25 (13.4) | 117 (14.6) | 0.634 |
| 2+ | 43 (23.0) | 215 (26.9) | |
| 3+ | 64 (34.2) | 251 (31.4) | |
| Diagnosis by GeneXpert | 55 (29.4) | 217 (27.1) | |
Anti-tuberculosis regimen | 2RHZE/4RH | 105 (56.1) | 496 (62.0) | 0.172 |
| 2RHZE/6HE | 63 (33.7) | 250 (31.2) | |
| 2RHZES/1RHZE/5RHE | 19 (10.2) | 54 (6.8) | |
HIV status | Negative | 113 (60.4) | 591 (73.9) | < 0.001 |
| Positive | 74 (39.6) | 209 (26.1) | |
Type of Directly Observed Therapy Short Course | Health facility | 12 (6.4) | 33 (4.1) | 0.247 |
| Community | 175 (93.6) | 767 (95.9) | |
Treatment supporter availability | No | 24 (12.8) | 98 (12.2) | 0.924 |
| Yes | 163 (87.2) | 702 (87.8) | |
Lives in same sub-county where health facility is located | Yes | 60 (39.5) | 312 (45.4) | 0.214 |
| No | 92 (60.5) | 375 (54.6) | |
Note: 1) 2RHZE/4RH: 2 months of Rifampicin (R), Isoniazid (H), Pyrazinamide (Z),Ethambutol / 4 months of RH; 2) 2RHZE/6EH: 2 months of RHZE)/ 6 months of EH; 3) 2RHZES/IRHZE/5RHE: 2 months of RHZE, Streptomycin/One month of RHZE/ 5 months of RHE |
Table 2
Study profile and tuberculosis treatment outcomes by district in eastern Uganda
Characteristics | Soroti n = 541 | Kumi n = 279 | Ngora n = 148 | Serere n = 155 | Total n = 1,123 |
Treatment outcomes (n = 1,123) | No. (%) | No. (%) | No. (%) | No. (%) | No. (%) |
Cured | 247 (45.7) | 122 (43.7) | 31 (20.9) | 77 (49.7) | 477 (42.5) |
Completed treatment | 112 (20.7) | 57 (20.4) | 84 (56.8) | 70 (45.2) | 323 (28.8) |
Failed treatment | 10 ( 1.8) | 6 ( 2.2) | 0 ( 0.0) | 1 ( 0.6) | 17 (1.5) |
Died | 45 ( 8.3) | 15 ( 5.4) | 16 (10.8) | 5 ( 3.2) | 81 (7.2) |
Lost to follow-up | 49 ( 9.1) | 28 (10.0) | 10 ( 6.8) | 2 ( 1.3) | 89 (7.9) |
Treatment outcome missing | 78 (14.4) | 51 (18.3) | 7 ( 4.7) | 0 ( 0.0) | 136 (12.1) |
Tuberculosis treatment outcome available n = 987 | Soroti n = 463 | Kumi n = 228 | Ngora n = 141 | Serere n = 155 | Total n = 987 |
Unsuccessful | 104 (22.5) | 49 (21.5) | 26 (18.4) | 8 (5.2) | 187 (18.9) |
Successful | 359 (77.5) | 179 (78.5) | 115 (81.6) | 147 (94.8) | 800 (81.1) |
Total | 463 | 228 | 141 | 155 | 987 |
Note: In computation of mortality and treatment success, participants with missing treatment outcome (n = 136) were excluded. |
The treatment outcomes for the 1,123 records were as follows: 477 (42.5%) cured, 323 (28.8%) completed treatment with no cure, 17 (1.5%) failed treatment, 81 (7.2%) died, 89 (7.9%) lost to follow-up, and 136 (12.1%) had no treatment outcome data in the records. Table 1 shows the results of the treatment outcome stratified by district of assessment. After excluding participants with missing treatment outcome, revised analysis showed 800 (81.1%) were successfully treated.
Factors associated with successful treatment of tuberculosis
Table 3 is a summary of results at unadjusted and adjusted analyses. In unadjusted analysis, participants from Serere district had increased chances of successful treatment of tuberculosis compared to those from Soroti district (RR, 1.22; 95% CI, 1.15–1.30). However, successful treatment of tuberculosis was lower among males compared to females (RR, 0.91; 95% CI, 0.86–0.96), more than 50 years of age than 15 to 34 years of age (RR, 0.88; 95% CI, 0.81–0.97), retreatment persons with BC-PTB compared to new ones (RR, 0.90; 95% CI, 0.80-1.00), and HIV infected than HIV non-infected (RR, 0.88; 95% CI, 0.81–0.95).
Table 3
Factors associated with successful tuberculosis treatment at unadjusted and adjusted analysis
| | Tuberculosis treatment outcome | Modified Poisson regression analysis |
Characteristics | Level | Unsuccessful (No. (%)) | Successful (No. (%)) | Unadjusted analysis | Adjusted analysis |
Participants | | 187 (18.9) | 800 (81.1) | RR | 95% CI | aRR | 95% CI |
District | Soroti | 104 (55.6) | 359 (44.9) | Ref | | Ref | |
| Kumi | 49 (26.2) | 179 (22.4) | 1.01 | (0.93,1.10) | 1.02 | (0.94,1.11) |
| Ngora | 26 (13.9) | 115 (14.4) | 1.05 | (0.96,1.15) | 1.04 | (0.95,1.14) |
| Serere | 8 (4.3) | 147 (18.4) | 1.22*** | (1.15,1.30) | 1.22*** | (1.14,1.30) |
Sex | Female | 46 (24.6) | 290 (36.2) | 1 | | 1 | |
| Male | 141 (75.4) | 510 (63.7) | 0.91** | (0.86,0.96) | 0.92** | (0.87,0.98) |
Age group | 15–34 | 73 ( 39.0) | 387 ( 48.4) | 1 | | 1 | |
| 35–50 | 66 ( 35.3) | 262 ( 32.8) | 0.98 | (0.92,1.05) | 0.97 | (0.91,1.04) |
| More than 50 | 48 ( 25.7) | 151 ( 18.9) | 0.88** | (0.81,0.97) | 0.89** | (0.81,0.97) |
Type of persons with tuberculosis | New | 154 ( 82.4) | 708 ( 88.5) | 1 | | 1 | |
| Retreatment | 33 ( 17.6) | 92 ( 11.5) | 0.90* | (0.80,1.00) | 0.94 | (0.84,1.05) |
HIV status | Negative | 111 ( 60.0) | 583 ( 73.6) | 1 | | 1 | |
| Positive | 74 ( 40.0) | 209 ( 26.4) | 0.88** | (0.81,0.95) | 0.88** | (0.82,0.95) |
Note: 95% confidence intervals for risk ratio (RR) in brackets; * p < 0.05, ** p < 0.01, *** p < 0.001; RR: Unadjusted risk ratio; aRR: Adjusted risk ratio |
When we adjusted for all statistically significant factors, successful treatment of tuberculosis was independently associated with being male (aRR, 0.92; 95% CI, 0.87–0.98), older than 50 years of age (aRR, 0.89; 95% CI, 0.81–0.97), being HIV infected (aRR, 0.88; 95% CI, 0.82–0.95) and a resident from Serere compared to Soroti district (aRR, 1.22; 1.14–1.30),
Baseline characteristics of persons with BC-PTB by survival status
Table 4 shows the distribution of participant characteristics stratified by survival, namely alive or died. Of 987 participants whose treatment outcomes were evaluated, 81 (8.2%) died. Most of the deaths were at referral hospital level (40/81 or 49.4%) and in 2015 (35/81 or 43.2%). Participants who died were on average older than those who were alive: 44.80 ± 16.82 versus 37.95 ± 15.05 years, p < 0.001. There was a statistically significant difference in mortality based on the district where treatment was received, level of health facility, year of tuberculosis treatment, participants’ age, participant HIV sero-status, and form of DOTs.
Table 4
Baseline characteristics of alive and dead participants
Characteristics | Level | Patient alive n = 906 (91.8%) | Patient died n = 81 (8.2%) | P-value |
District | Soroti | 418 (46.1) | 45 (55.6) | 0.027 |
| Kumi | 213 (23.5) | 15 (18.5) | |
| Ngora | 125 (13.8) | 16 (19.8) | |
| Serere | 150 (16.6) | 5 (6.2) | |
Level of health facility | Health Center IV | 386 (42.6) | 22 (27.2) | 0.023 |
| District Hospital | 182 (20.1) | 19 (23.5) | |
| Referral Hospital | 338 (37.3) | 40 (49.4) | |
Location of health facility | Rural | 252 (27.8) | 23 (28.4) | 1.000 |
| Peri-urban | 654 (72.2) | 58 (71.6) | |
Type of health facility ownership | Public | 808 (89.2) | 72 (88.9) | 1.000 |
| Private not for profit | 98 (10.8) | 9 (11.1) | |
Year of tuberculosis treatment | 2015 | 332 (36.6) | 35 (43.2) | 0.022 |
| 2016 | 192 (21.2) | 25 (30.9) | |
| 2017 | 209 (23.1) | 14 (17.3) | |
| 2018 | 173 (19.1) | 7 (8.6) | |
Age category (years) | 15–34 | 436 (48.1) | 24 (29.6) | 0.002 |
| 35–50 | 297 (32.8) | 31 (38.3) | |
| > 50 | 173 (19.1) | 26 (32.1) | |
| Mean (SD) | 37.95 (15.05) | 44.80 (16.82) | < 0.001 |
Sex | Male | 593 (65.5) | 58 (71.6) | 0.319 |
| Female | 313 (34.5) | 23 (28.4) | |
Type of tuberculosis patient | New | 792 (87.4) | 70 (86.4) | 0.933 |
| Previously treated | 114 (12.6) | 11 (13.6) | |
Transfer in | No | 830 (91.6) | 73 (90.1) | 0.801 |
| Yes | 76 (8.4) | 8 (9.9) | |
Pre-therapy bacilli load | 1+ | 130 (14.3) | 12 (14.8) | 0.948 |
| 2+ | 238 (26.3) | 20 (24.7) | |
| 3+ | 287 (31.7) | 28 (34.6) | |
| GeneXpert | 251 (27.7) | 21 (25.9) | |
Anti-tuberculosis regimen | 2RHZE/4RH | 560 (61.8) | 41 (50.6) | 0.136 |
| 2RHZE/6HE | 280 (30.9) | 33 (40.7) | |
| 2RHZES/1RHZE/5RHE | 66 (7.3) | 7 (8.6) | |
HIV status | Negative | 673 (74.3) | 31 (38.3) | < 0.001 |
| Positive | 233 (27.7) | 50 (61.7) | |
Type of Directly Observed Therapy Short Course | Health facility | 36 (4.0) | 9 (11.1) | 0.008 |
| Community | 870 (96.0) | 72 (88.9) | |
Treatment support availability | No | 111 (12.3) | 11 (13.6) | 0.864 |
| Yes | 795 (87.7) | 70 (86.4) | |
Note: 1) 2RHZE/4RH: 2 months of Rifampicin (R), Isoniazid (H), Pyrazinamide (Z),Ethambutol / 4 months of RH; 2) 2RHZE/6EH: 2 months of RHZE)/ 6 months of EH; 3) 2RHZES/IRHZE/5RHE: 2 months of RHZE, Streptomycin/One month of RHZE/ 5 months of RHE |
Factors associated with mortality among persons with BC-PTB
Table 5 presents results for factors associated with mortality. In unadjusted analysis, mortality was lower among participants who received treatment under community-based DOTS than facility-based DOTS (RR, 0.38; 95% CI, 0.20–0.71). However, mortality was more likely to occur when treatment of tuberculosis was given at a Referral Hospital compared to a Health Center IV level (RR, 1.96; 95% CI, 1.19–3.24), persons with BC-PTB older than 50 years of age compared to 15 to 34 years (RR, 2.50; 95% CI, 1.47–4.25), and HIV infected compared to HIV non-infected (RR, 4.01; 95% CI, 2.62–6.15).
Table 5
Factors associated with mortality among persons with BC-PTB in rural eastern Uganda
Characteristics | Level | Patient alive n = 906 (91.8%) | Patient died n = 81 (8.2%) | Modified Poisson regression analysis |
| | | | Unadjusted analysis (RR, 95% CI) | Adjusted analysis (RR, 95% CI) |
District | Soroti | 418 (46.1) | 45 (55.6) | Ref | | Ref | |
| Kumi | 213 (23.5) | 15 (18.5) | 0.68 | (0.39,1.19) | 0.74 | (0.25,2.18) |
| Ngora | 125 (13.8) | 16 (19.8) | 1.17 | (0.68,2.00) | 1.74 | (0.63,4.82) |
| Serere | 150 (16.6) | 5 (6.2) | 0.33* | (0.13,0.82) | 0.57 | (0.18,1.88) |
Level of health facility | Health Center IV | 386 (42.6) | 22 (27.2) | Ref | | Ref | |
| District Hospital | 182 (20.1) | 19 (23.5) | 1.75 | (0.97,3.16) | 1.38 | (0.69,2.75) |
| Referral Hospital | 338 (37.3) | 40 (49.4) | 1.96** | (1.19,3.24) | 1.99 | (0.81,4.89) |
Year of tuberculosis treatment | 2015 | | | Ref | | Ref | |
| One year increase | | | 0.78** | (0.64,0.93) | 0.80* | (0.66,0.97) |
Age group | 15–34 | 436 (48.1) | 24 (29.6) | Ref | | Ref | |
| 35–50 | 297 (32.8) | 31 (38.3) | 1.81* | (1.08,3.03) | 1.56 | (0.96,2.55) |
| > 50 | 173 (19.1) | 26 (32.1) | 2.50*** | (1.47,4.25) | 2.93*** | (1.74,4.92) |
HIV status | Negative | 673 (74.3) | 31 (38.3) | Ref | | Ref | |
| Positive | 233 (27.7) | 50 (61.7) | 4.01*** | (2.62,6.15) | 4.48*** | (2.95,6.79) |
Type of Directly Observed Therapy Short Course | Facility | 36 (4.0) | 9 (11.1) | Ref | | Ref | |
| Community | 870 (96.0) | 72 (88.9) | 0.38** | (0.20,0.71) | 0.26*** | (0.13,0.50) |
Note: 95% confidence intervals for risk ratio (RR) in brackets; * p < 0.05, ** p < 0.01, *** p < 0.001; RR: Unadjusted risk ratio; aRR: Adjusted risk ratio. |
In the adjusted analysis, mortality was lower when tuberculosis treatment was initiated in the years after 2015, with a 20% reduction for every one year lapse from 2015 up to 2018 when the last data were retrieved (aRR, 0.80; 95% CI, 0.66–0.97). Delivery of tuberculosis treatment under community DOTS was protective of mortality (aRR, 0.26; 95% CI, 0.13–0.50). But mortality was higher among persons with BC-PTB aged 50 years and older (aRR, 2.93; 95% CI, 1.74–4.92) and those who were HIV infected (aRR, 4.48; 95% CI, 2.95–6.79).