Assessment of treatment outcomes and their predictors among tuberculosis patients in the directly observed treatment short course strategy; case study: Mpigi district

Abstract

The WHO’s 194 Member States endorsed the End TB strategy during the 2014 World Health Assembly for the period 2016–2035. To achieve the targets starting 2020, the Directly Observed Treatment Short course (DOTS) intervention has been intensified globally. With the TB regimen it is perceived that the TB DOTS intervention/strategy can augment treatment completion and cure rates among patients. However to date there have been variations in the effects and achievements of the DOTS strategy between countries, yet more than 187 countries have implemented DOTS. Tuberculosis (TB) is still one of the top 10 causes of death worldwide, with increments in each year. In Uganda where both facility-based and CBDOTs are available, TB prevalence stands at 253 per 100,000 people, compared to 159 per 100,000 in 2015, with over 1700 MDR-TB cases registered. Mpigi, is no different, although the DOTS has been implemented in the district, more than 1000 cases of TB are detected annually with loss to follow up rates exceeding 20%. This calls for the evaluation of the strategy and the establishment of what predicts treatment outcomes among beneficiaries.The purpose of this study was to assess treatment outcomes and their predictors among tuberculosis patients in the directly observed treatment short course intervention of Mpigi district. The study was conducted in Mpigi district using a retrospective chart review (RCR) design, among Tuberculosis patients who had been receiving treatment in the TB DOTS intervention of Mpigi district in the year 2016 and 2017. The sample size was determined using a formula by Yamane (1967). Mpigi district was selected because it is representative of rural Uganda (NPHC 2014); public health facilities were targeted and randomly sampled using simple random sampling technique. Data was collected using data abstraction method, and captured using the data abstraction form. Statistical analysis was performed using SPSS version 20, in which descriptive statistics were done, and Fishers exact test, Chi Square tests and the binary logistic regression was done to analyze relationships between variables. The majority of the TB patients, whose records were sampled, had successful treatment outcomes 83% (208/250) while 17% (42/250) had unsuccessful treatment. The individual predictors of successful treatment outcomes among patients under DOTs include; Patient Smear at 2nd month of follow up (AOR = 3.373, CI = 1.811 - 5.253) and Patient Smear at 5th month of follow up (AOR = 8.820, CI = 3.215 - 10.115). While only the type of DOTs the patient was treated under (AOR = 7.181, CI = 2.952 - 9.136) was predictive of treatment outcomes among the DOTS strategy related characteristics. Between the years 2016 and 2017, the DOTS intervention/strategy had substantial effect on the treatment outcomes of patients who were treated under it; about 8 of every 10 patients who were treated under DOTS had successful treatment outcomes. The treatment outcomes of patients under DOTS are predicted by majorly individual patient characteristics and to a relatively smaller extent by intervention characteristics. Treatment outcomes among patients on DOTs can be further improved by augmenting counseling in case of positive smear at 2nd month, and putting emphasis on the CBDOTS arm of the DOTs intervention. The study could not assess treatment outcomes of those patients who could have been diagnosed alternatively e.g. using Urine TB LAM as these were not available in the context of Mpigi during the period of the study. Further research is needed to assess treatment outcomes among patients diagnosed by different diagnostic modalities other than clinical diagnosis, sputum analysis, Gene expert and Chest X-ray.