TY - JOUR
T1 - Comparison of first-line tuberculosis treatment outcomes between previously treated and new patients: a retrospective study in Machakos subcounty, Kenya
AU - Ndambuki, Johannes
AU - Nzomo, Joseph
AU - Muregi, Lucy
AU - Mutuku, Chris
AU - Makokha, Francis
AU - Nthusi, Jonathan
AU - Ambale, Clarice
AU - Lynen, Lutgarde
AU - Decroo, Tom
N1 - FTX; OGOA; (CC BY 4.0); © The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Antitubercular Agents/therapeutic use
KW - Humans
KW - Kenya/epidemiology
KW - Microbial Sensitivity Tests
KW - Mycobacterium tuberculosis
KW - Retrospective Studies
KW - Treatment Outcome
KW - Tuberculosis, Multidrug-Resistant
KW - Tuberculosis/drug therapy
U2 - 10.1093/inthealth/ihaa051
DO - 10.1093/inthealth/ihaa051
M3 - A1: Web of Science-article
C2 - 32860045
SN - 1876-3413
VL - 13
SP - 272
EP - 280
JO - International Health
JF - International Health
IS - 3
ER -