Comparison of first-line tuberculosis treatment outcomes between previously treated and new patients: a retrospective study in Machakos subcounty, Kenya

Johannes Ndambuki, Joseph Nzomo, Lucy Muregi, Chris Mutuku, Francis Makokha, Jonathan Nthusi, Clarice Ambale, Lutgarde Lynen, Tom Decroo

Research output: Contribution to journalA1: Web of Science-article

Abstract

BACKGROUND: Since 2016, patients with rifampicin-susceptible tuberculosis (TB) have been treated with the 6-month first-line regimen, regardless of treatment history. We assessed treatment outcomes of previously treated and new patients in Machakos subcounty, Kenya.

METHODS: We performed a retrospective cohort study in patients started on first-line treatment between 2016 and 2017. Firth's logistic regression was used to estimate the effect of previous treatment on having a programmatic adverse outcome (either lost to follow-up, death, failure) and treatment failure vs treatment success (either cure or completion).

RESULTS: Of 1024 new and 79 previously treated patients, 88.1% and 74.7% were treated successfully, 6.5% and 7.6% died, 4.2% and 10.1% were lost to follow-up and 1.2% and 7.6% had treatment failure, respectively. Previous treatment predicted having a programmatic adverse outcome (adjusted odds ratio [aOR] 2.4 [95% confidence interval {CI} 1.4 to 4.2]) and treatment failure (aOR 7.3 [95% CI 2.6 to 20.4]) but not mortality. Similar correlations were found in 334 new and previously treated patients with confirmed baseline rifampicin susceptibility.

CONCLUSION: Previously treated patients were more at risk of experiencing a poor treatment outcome, mainly lost to follow-up and treatment failure. Adherence support may reduce lost to follow-up. Rifampicin drug susceptibility testing coverage should increase. More robust retreatment regimens may reduce treatment failure.

Original languageEnglish
JournalInternational Health
Volume13
Issue number3
Pages (from-to)272-280
Number of pages9
ISSN1876-3413
DOIs
Publication statusPublished - 2021

Keywords

  • Antitubercular Agents/therapeutic use
  • Humans
  • Kenya/epidemiology
  • Microbial Sensitivity Tests
  • Mycobacterium tuberculosis
  • Retrospective Studies
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant
  • Tuberculosis/drug therapy

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