Predicting treatment outcomes among HIV/TB coinfected patients in the east and north-eastern Uganda; a retrospective cohort study.

Abstract

Introduction Successful tuberculosis treatment outcomes are still below the WHO end TB targets of = 90% despite the improvement in the availability of TB prevention, treatment, and care services. From the literature, it is known that socio-demographic and healthcare system factors influence TB treatment outcomes. Still, there is a paucity of locally generated data on socio-demographic and healthcare system factors influencing TB treatment outcomes in Uganda. This study was conducted to identify factors that predict TB treatment outcomes in East and North Eastern Uganda. Objectives The overarching objective of this study was to determine patient characteristics, TB treatment outcomes and their predictors among TB/HIV co-infected individuals in East and North Eastern Uganda. Methods A retrospective cohort study was conducted in Mbale, Soroti, and Moroto Regional Referral Hospitals. A disproportionate stratified random sample of 324 HIV/TB co-infected patients was selected. Data was collected using a pre-tested structured data extraction form. Stata statistical software version 13.1 was used for analysis. Bivariate and multivariate analysis was done to infer the association between TB treatment outcome and a potential predictor variable. Adjusted Odds ratios with their 95% confidence intervals were calculated. Results Of the 324 TB/HIV co-infected patients included in the study, overall, 71.9% achieved treatment success while 28.1% had unsuccessful treatment outcomes. Of those with successful treatment outcomes, 41% got cured, and 30.9% completed their treatment. The unsuccessful treatment outcomes were due to loss to follow-up (12.7%), death (9.9%), treatment failure (0.3%), and unknown treatment outcomes (5.2%). Having the mean baseline weight of =49.6 kg (AOR=5.0, 95% CI; 1.2-21.4), being retreatment case (AOR=3.8, 95% CI; 0.03-55.0) and being enrolled on ART (AOR=2.8, 95%CI; 0.1-12.8) were positively associated with successful TB treatment outcomes while living more than 5 kilometers from the facility (AOR=0.6, 95% CI; 0.2-2.1), having PCD (AOR=0.9, 95% CI; 0.1-8.6), having PBC (AOR=0.1, 95% CI; 0.02-1.4), having sputum unmonitored at 5 months (AOR= 0.05; 95% CI; 0.01-0.5) and having late HIV clinical stage (AOR=0.3, 95% CI; 0.03-3.4) were negatively associated with successful TB treatment outcome Conclusion The treatment success rate among TH/HIV co-infected patients obtained in this study was below the desired WHO target of =90%. The low treatment success rate registered in this study requires urgent action to scale up the management of TB/HIV co-infection in Uganda.