The mean age ± SD was 35.5±15.5. The proportion of males was more (58 %) than the females (Table 1). Majority of the TB patients were in the productive age of 24-35 years of age (33.4 %) and were HIV positive (38.4 %). Patient enrollment increased from 22.0 % to 39.6 % over the 15-year period, with the enrollment of HIV positive TB patients also increasing from 2.3 % to 57.7 %. Mean time-outcome ± SD was 5.4 ± 3.0 (time in months).
Table 1: Demographic Characteristics of TB Patients by HIV Status (n=10156)
Variable
|
HIV Negative (n=3,733)
Freq.(%)
|
HIV Positive
(n=2,968)
Freq.(%)
|
Unknown HIV
Status (n=3455)
Freq.(%)
|
Total
Freq.(%)
|
χ2 (p)
|
Sex
|
|
|
|
|
|
Male
|
2467(66.1)
|
1343(45.2)
|
2094(60.6)
|
5904(58.1)
|
331.9
|
Female
|
1266(33.9)
|
1625(54.8)
|
1361(39.4)
|
4252(41.9)
|
(<0.001)
|
Age (Years)
|
|
|
|
|
|
0-14
|
159(4.5)
|
93(3.3)
|
297(14.5)
|
549(6.5)
|
589.6
|
15-24
|
503(14.2)
|
237(8.5)
|
261(12.7)
|
1001(11.9)
|
(<0.001)
|
25-34
|
1135(31.9)
|
1069(38.4)
|
598(29.2)
|
2802(33.4)
|
|
35-44
|
686(19.3)
|
856(30.8)
|
431(21.0)
|
1973(23.5)
|
|
45-54
|
489(13.8)
|
364(13.1)
|
238(11.6)
|
1091(13.0)
|
|
>54
|
582(16.4)
|
163(5.9)
|
228(11.1)
|
972(11.6)
|
|
Not Recorded
|
|
|
|
1768(17.4)
|
|
Patient Residence
|
|
|
|
|
|
Jos North
|
1393(37.3)
|
1188(40.0)
|
1992(57.7)
|
4573(45.0)
|
1406.5
|
Jos South
|
390(10.4)
|
446(15.0)
|
594(17.2)
|
1430(14.1)
|
(<0.001)
|
Jos East
|
139(3.7)
|
127(4.3)
|
194(5.6)
|
460(4.5)
|
|
Other LGAs in Plateau
|
992(26.6)
|
531(17.9)
|
540(15.6)
|
2063(20.3)
|
|
Other States Outside Plateau
|
133(3.6)
|
138(4.6)
|
134(3.9)
|
405(4.0)
|
|
Not recorded
|
|
|
|
1229(12.1)
|
|
Year of Enrollment
|
|
|
|
|
|
2001-2005
|
0(0.0)
|
67(2.3)
|
2169(62.8)
|
2236(22.0)
|
5743.5
|
2006-2010
|
1531(41.0)
|
1188(40.0)
|
1179(34.1)
|
3898(38.4)
|
(<0.001)
|
2011-2015
|
2202(59.0)
|
1713(57.7)
|
107(3.1)
|
4022(39.6)
|
|
Freq.=Frequency, LGAs=Local Government Areas
Majority of the patients were new (93.3 %), pulmonary TB (92.4 %) patients. Most of the patients that returned after default, relapsed, developed multidrug resistance, or needed retreatment TB were HIV negative TB Patients. Non-adherence/defaulting rate was 18.5 %, with majority of the patients, especially those with unknown HIV status defaulting at the end of intensive phase. The sputum conversion rate was 72.8 % (Table 2).
Table 2: Clinical Characteristics of Tuberculosis Patients by HIV Status (n = 10,156)
Variable
|
HIV Negative (n=3,733)
Freq.(%)
|
HIV Positive
(n=2968)
Freq.(%)
|
Unknown HIV
Status (n=3455)
Freq.(%)
|
Total
Freq.(%)
|
χ2(p)
|
TB Diagnosis
|
|
|
|
|
|
Pulmonary TB
|
3311(88.7)
|
2818(94.9)
|
3258(94.3)
|
9387(92.4)
|
220.7
|
TB Spine
|
227(6.1)
|
29(1.0)
|
92(2.7)
|
348(3.4)
|
(<0.001)
|
TB Adenitis
|
39(1.0)
|
22(0.7)
|
19(0.5)
|
80(0.8)
|
|
TB Abdomen
|
135(3.6)
|
91(3.1)
|
61(1.8)
|
287(2.8)
|
|
Others*
|
21(0.6)
|
8(0.3)
|
25(0.7)
|
54(0.5)
|
|
TB Category
|
|
|
|
|
|
New
|
3405(91.2)
|
2778(93.6)
|
3290(95.2)
|
9473(93.3)
|
117.9
|
RAD/TALF
|
104(2.8)
|
59(2.0)
|
55(1.6)
|
218(2.1)
|
(<0.001)
|
Relapse
|
161(4.3)
|
72(2.4)
|
49(1.4)
|
282(2.8)
|
|
MDR-TB
|
11(0.3)
|
7(0.2)
|
1(0.0)
|
19(0.2)
|
|
Transfer-In
|
52(1.4)
|
52(1.8)
|
60(1.7)
|
164(1.6)
|
|
Needing Retreatment
|
|
|
|
|
|
No
|
3290(88.1)
|
2704(91.1)
|
2979(86.2)
|
8973(88.3)
|
242.7
|
Yes
|
282(7.6)
|
136(4.6)
|
104(3.0)
|
522(5.1)
|
(<0.001)
|
Indeterminate+
|
161(4.3)
|
128(4.3)
|
372(10.8)
|
661(6.5)
|
|
Sputum AFB on Diagnosis
|
|
|
|
|
|
Sputum Negative
|
2355(63.1)
|
2398(80.8)
|
2480(71.8)
|
7233(71.2)
|
253.8
|
Sputum AFB Positive
|
1378(36.9)
|
570(19.2)
|
975(28.2)
|
2923(28.8)
|
(<0.001)
|
Sputum AFB After Intensive Phase
|
|
|
|
|
|
Sputum Negative
|
3510(94.0)
|
2806(94.5)
|
3044(88.1)
|
9360(92.2)
|
162.6
|
Sputum AFB Positive
|
39(1.0)
|
18(0.6)
|
12(0.3)
|
69(0.7)
|
(<0.001)
|
Indeterminate+
|
184(4.9)
|
144(4.9)
|
398(11.5)
|
726(7.1)
|
|
Defaulting Period (n=1874)
|
|
|
|
|
|
During Intensive Phase
|
97(2.6)
|
65(2.2)
|
271(7.8)
|
433(4.3)
|
1126.7
|
End of Intensive Phase
|
190(5.1)
|
191(6.4)
|
559(16.2)
|
940(9.3)
|
(0.005)
|
Continuation Phase
|
96(2.6)
|
62(2.1)
|
343(9.9)
|
501(4.9)
|
|
Binary Outcome
|
|
|
|
|
|
Unsuccessful
|
919(24.6)
|
781(26.3)
|
1599(46.3)
|
3299(32.5)
|
457.2
|
Successful
|
2814(75.4)
|
2187(73.7)
|
1855(53.7)
|
6856(67.5)
|
(<0.001)
|
*=Disseminated TB, Miliary TB, Ovarian TB, Pleural TB, Skin TB, Heart TB;
+Indeterminate due to lost to follow-up or death during intensive phase of treatment
TALF=Treatment after lost to follow up, RAD = Return after Default
The patient enrollment in 2001 was 360 patients, which rose to a peak of 983 patients in 2013, but decreased to 721 in 2015 (Figure 1).
Treatment success was highest in OLA hospital (86.2 %), and non-adherence/defaulting rate was highest in Plateau State Specialist Hospital (26.4 %). Mortality rate was highest (10.5 %) in CHRC Mangu (Table 3).
Table 3: Treatment Outcomes from DOT Centers
|
Successful Treatment Freq. (%)
|
Defaulted Freq. (%)
|
Treatment Failure Freq. (%)
|
Died
Freq. (%)
|
Discontinued Treatment Freq. (%)
|
Transfer-Out Freq.(%)
|
Total
|
OLA
|
1189 (86.2)
|
58 (4.2)
|
15 (1.1)
|
79 (5.7)
|
2 (0.2)
|
36 (2.6)
|
1379 (13.6)
|
FAF
|
1126 (85.6)
|
81 (6.2)
|
4 (0.3)
|
84 (6.4)
|
0 (0.0)
|
20 (1.5)
|
1315 (12.9)
|
CHRC
|
1467 (77.3)
|
55 (2.9)
|
4 (0.2)
|
199 (10.5)
|
1 (0.1)
|
172 (9.1)
|
1898 (18.7)
|
PSSH
|
1872 (58.2)
|
848 (26.4)
|
17 (0.5)
|
236 (7.3)
|
11 (0.3)
|
233 (7.2)
|
3217 (31.7)
|
BUTH
|
1190 (50.7)
|
846 (36.1)
|
11 (0.5)
|
161 (6.9)
|
4 (0.2)
|
135 (5.8)
|
2347 (23.1)
|
Total
|
6844 (67.4)
|
1888 (18.6)
|
51 (0.5)
|
759 (7.5)
|
18 (0.2)
|
596 (5.9)
|
10156.0
|
OLA=Our Lady of Apostles Hospital; FAF= Faith Alive Foundation Hospital; CHRC= COCIN Hospital and Rehabilitation Centre Mangu; BUTH=Bingham University Teaching Hospital; PSSH= Plateau State Specialist Hospital
Distribution of Tuberculosis Treatment Outcomes by HIV Status
TB patients with known HIV status had higher treatment success rates than those with unknown HIV status. Non-adherence/defaulting rate was highest (34.0 %) among TB patients with unknown HIV status and mortality was highest (11.2 %) among HIV positive TB patients (Table 4)
Table 4: Distribution of Tuberculosis Treatment Outcomes by HIV Status
Treatment Outcome
|
HIV Negative (n=7,169)
Freq.(%)
|
HIV Positive
(n=2,967)
Freq.(%)
|
Unknown HIV
Status (n=20)
Freq.(%)
|
Total
Freq.(%)
|
χ2(p)
|
Transfer-Out
|
227(6.1)
|
117(3.9)
|
251(7.3)
|
595(5.9)
|
970.9
|
Cured
|
1,037(27.8)
|
488(16.4)
|
514(14.9)
|
2039(20.1)
|
(<0.001)
|
Treatment Completed
|
1777(47.6)
|
1,699(57.2)
|
1341(38.8)
|
4817(47.4)
|
|
Treatment Success
|
2,814(75.4)
|
2,187(73.7)
|
1855(53.7)
|
6856(67.5)
|
|
Defaulted
|
383(10.3)
|
318(10.7)
|
1173(34.0)
|
1874(18.5)
|
|
Treatment Failure
|
33(0.9)
|
11(0.4)
|
9(0.3)
|
53(0.5)
|
|
Died
|
266(7.1)
|
331(11.2)
|
162(4.7)
|
759(7.5)
|
|
Discontinued Trt.
|
10(0.3)
|
4(0.1)
|
4(0.1)
|
18(0.2)
|
|
Trt=Treatment, Freq.=Frequency
The trend of treatment outcomes in figure 2 showed a steady increase in treatment success over the years was seen with a peak at 83.8 % in 2011, but dropped to a low 64.4% in 2015. A consequent reverse trend was seen in unsuccessful treatment, with a peak in 2002 (59.9%) and 30.5% in 2015.
Factors Associated with Tuberculosis Medication Non-adherence
Compared to HIV positive TB patients, TB patients were 4.3 times more likely to default/not adhere if they did not know their HIV status in the course of their TB treatment (CI: 3.74-4.91, p < 0.001). Males had a 1.15 times likelihood of medication non-adherence than females (CI: 1.036-1.272, p = 0.008). TB patients with a history of non-adherence had a 2.3 higher likelihood to default again from taking their anti-TB medicines (CI: 1.34-3.87, p = 0.002) (Table 5).
Table 5: Factors Associated with Tuberculosis Medication Non-adherence
Variable
|
df
|
P
|
OR
|
95 % Confidence Interval
Upper Lower
|
Sex
|
|
|
|
|
|
Male
|
1
|
0.008*
|
1.150
|
1.036
|
1.272
|
Female
|
|
|
|
|
|
HIV Status
|
|
|
|
|
|
Negative
|
1
|
0.546
|
0.950
|
0.810
|
1.110
|
Unknown
|
1
|
0.001*
|
4.290
|
3.740
|
4.910
|
Positive
|
2
|
|
|
|
|
TB Category
|
|
|
|
|
|
New
|
1
|
0.147
|
1.380
|
0.890
|
2.160
|
TALF/RAD
|
1
|
0.002*
|
2.270
|
1.340
|
3.870
|
Relapse
|
1
|
0.871
|
0.950
|
0.550
|
1.670
|
MDR-TB
|
1
|
0.055
|
2.830
|
0.980
|
8.190
|
Others
|
4
|
|
|
|
|
TALF/RAD=Treatment After Lost to Follow-up/Return After Default; MDR-TB=Multi-Drug Resistant TB; OR= Odds ratio; *Statistically significant at p<0.05; Others=Transfer-In
Factors Associated with Mortality
HIV negative TB patients and those not needing retreatment were less likely to be associated with mortality than HIV positive TB patients. Extra pulmonary TB patients were 2.3 times more likely to be associated with mortality than pulmonary TB patients (Table 6).
Table 6: Factors Associated with Mortality
Variable
|
df
|
P
|
OR
|
95 % Confidence Interval
Upper Lower
|
Sex
|
|
|
|
|
|
Female
|
1
|
0.104
|
0.879
|
0.752
|
1.027
|
Male
|
|
|
|
|
|
HIV Status
|
|
|
|
|
|
HIV negative
|
1
|
0.001*
|
0.434
|
0.371
|
0.508
|
HIV Positive
|
1
|
0.068
|
0.312
|
0.089
|
1.092
|
Unknown status
|
2
|
|
|
|
|
TB Category
|
|
|
|
|
|
RAD
|
1
|
0.472
|
1.535
|
0.478
|
4.930
|
Relapse
|
1
|
0.011*
|
5.131
|
1.459
|
18.045
|
Treatment Failure
|
1
|
0.015*
|
4.191
|
1.323
|
13.273
|
New
|
3
|
|
|
|
|
TB Diagnosis
|
|
|
|
|
|
EPTB
|
1
|
0.001*
|
2.346
|
1.848
|
2.978
|
PTB
|
|
|
|
|
|
Needing Retreatment
|
|
|
|
|
|
No
|
1
|
0.913
|
1.022
|
0.687
|
1.522
|
Yes
|
1
|
0.001*
|
0.239
|
0.192
|
0.297
|
Indeterminate1
|
2
|
|
|
|
|
1= Indeterminate due to lost to follow up or death during intensive phase; *=Significant at p<0.05
Factors Associated with Treatment Success
A significant association between HIV status and treatment outcome was obtained after adjusting for sex and TB category. Being HIV positive was 2.8 times more likely to be associated with treatment success than having an unknown status. TALF/RAD, relapse and MDR-TB were less likely to be associated with treatment success than newly diagnosed TB patients (Table 7).
Table 7: Factors Associated with Treatment Success
Variable
|
df
|
P
|
OR
|
95 % Confidence Interval
Upper Lower
|
Sex
|
|
|
|
|
|
Female
|
1
|
0.243
|
1.060
|
0.961
|
1.170
|
Male
|
|
|
|
|
|
HIV Status
|
|
|
|
|
|
HIV negative
|
1
|
0.132
|
2.003
|
0.811
|
4.946
|
HIV Positive
|
1
|
0.028*
|
2.758
|
1.114
|
6.826
|
Unknown status
|
2
|
|
|
|
|
TB Category
|
|
|
|
|
|
TALF/RAD
|
1
|
0.024*
|
0.351
|
0.142
|
0.869
|
Relapse
|
1
|
0.029*
|
0.757
|
0.589
|
0.972
|
MDR-TB
|
1
|
0.001*
|
0.627
|
0.475
|
0.827
|
New
|
3
|
|
|
|
|
TALF/RAD=Treatment After Lost to Follow-up/Return After Default
MDR-TB=Multi-Drug Resistant TB