Study profile of persons with BC-PTB in eastern Uganda
Of 3,025 persons with TB treated between January 2015 and June 2018 shown in Figure 1, we excluded with reasons: 1) 1,881 persons without BC-PTB of which 1,636 were persons with clinically diagnosed TB and 45 were persons with extra-pulmonary TB; 2) 14 persons with BC-PTB because they were below 15 years of age, and; 3) seven persons with BC-PTB because they had multi-drug resistant TB. We therefore retrieved records for 1,123 adult persons with BC-PTB and further excluded 136 persons with BC-PTB with no treatment outcome evaluation either because they were transferred to another health facility or their treatment outcome was unknown to the reporting health facility at the time of data abstraction. Therefore, our subsequent analyses included 987 records for adult persons with BC-PTB.
Characteristics of participants with successful treatment outcome in eastern Uganda
We presented and compared the characteristics of participants with and without treatment success and the results are shown in Table 1. Participants who were successfully treated were on average younger than those who were unsuccessfully 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 persons with new BC-PTB diagnosis (708 (88.5%)). Other participant characteristics namely sex, age, and HIV status differed between those successful treated and those unsuccessfully treated.
There was no difference in treatment success rate with respect to health facility attributes (level, location, and ownership type), year of treatment, drug regimen and baseline bacilli. Sensitivity analysis results showed that the exclusion of persons with BC-PTB diagnosed by GeneXpert resulted in no change in proportions of treatment success (Chi-square test, p value changed from 0.634 to 0.511).
Distribution of treatment outcomes among persons with BC-PTB in eastern Uganda
The treatment outcomes for the 1,123 records were as follows: 477 (42.5%) cured, 323 (28.8%) treatment completed, 17 (1.5%) treatment failed, 81 (7.2%) died, 89 (7.9%) lost to follow-up, and 136 (12.1%) not evaluated. Table 1 shows the treatment outcomes stratified by district of assessment. After excluding not evaluated participants, revised analysis showed that 800 (81.1%) persons with BC-PTB were successfully treated.
Factors associated with treatment success among persons with BC-PTB in eastern Uganda
Table 3 is a summary of results at unadjusted and adjusted analyses. In unadjusted analysis, participants from Serere district had increased treatment success rate compared to those from Soroti district (RR, 1.22; 95% CI, 1.15-1.30). However, treatment success rate was lower among males compared to females (RR, 0.91; 95% CI, 0.86-0.96), those more than 50 years of age than 15 to 34 years of age (RR, 0.88; 95% CI, 0.81-0.97), previously treated persons with BC-PTB compared to persons with new BC-PTB diagnosis (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). When we adjusted for all statistically significant factors, treatment success was less likely to occur among males (aRR, 0.92; 95% CI, 0.87-0.98), patients older than 50 years of age (aRR, 0.89; 95% CI, 0.81-0.97), those HIV infected (aRR, 0.88; 95% CI, 0.82-0.95) but more among residents from Serere compared to Soroti district (aRR, 1.22; 1.14-1.30).
Baseline characteristics of persons with BC-PTB by survival status in eastern Uganda
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 rate based on the district where treatment was received, level of health facility, year of tuberculosis treatment, participants’ age, participant HIV sero-status, baseline bacilli, and form of DOTS. In sensitivity analysis, we found the exclusion of persons with BC-PTB diagnosed by GeneXpert resulted in no change in proportions of mortality (Chi-square test, p value changed from 0.948 to 0.887).
Factors associated with mortality among persons with BC-PTB in eastern Uganda
Table 5 presents results for factors associated with mortality rate. In the unadjusted analysis, mortality rate 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), when persons with BC-PTB were older than 50 years of age compared to 15 to 34 years (RR, 2.50; 95% CI, 1.47-4.25), and when persons with BC-PTB were HIV infected compared to HIV non-infected (RR, 4.01; 95% CI, 2.62-6.15). In 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-based DOTS was protective of mortality (aRR, 0.26; 95% CI, 0.13-0.50). But mortality rate 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).