INTENSIVE PHASE TREATMENT OUTCOME AND CONTRIBUTING FACTORS AMONG PATIENTS TREATED FOR MULTI DRUG RESISTANT TUBERCULOSIS IN ETHIOPIA

Abstract

Introduction: Multidrug-resistant Tuberculosis(MDRTB) is an infectious disease used to describe a strain of Mycobacterium tuberculosis that is resistant to at least Rifampicin and Isoniazid. The treatment success rate of patients in the cohort of 2012 with multi-drug resistant tuberculosis was only 50 %, largely because of high mortality and loss to follow-up. Monitoring the early treatment outcome and understanding the specific reasons for early unfavorable treatment outcome are important for evaluating the effectiveness of tuberculosis control program and predicting the final treatment outcome to tackle the emerging of extremely multi-drug resistant tuberculosis. Objective: The objective of this study was to determine intensive phase treatment outcome and contributing factors among patients treated for multi-drug resistant tuberculosis in Ethiopia. Methods: A 6 year retrospective cohort record review on multi-drug resistant tuberculosis registered from 2009 to 2014 was conducted in fourteen treatment initiating centers in Ethiopia. The records of 751 MDRTB patients were reviewed using stratified proportionate sampling with simple random sampling method. Data were collected by a pre-tested structured checklist prepared from a unit multi-drug resistant tuberculosis register. The data were entered into Epidata version 3.02 and after double entry verification they were analyzed using SPSS 20.0 software packages. After descriptive analysis, a multivariate analysis was conducted. Results: Nearly 66 % of the patients had favorable outcome after completing intensive phase treatment. After adjusting for potential confounders, the multivariable multinomial logistic regression model revealed that the independent factors associated with unknown intensive phase treatment outcome was found to be higher among ambulatory model of care ARRR: 3.158, 95%CI (1.612, 6.185) and lesser among urban dwellers [ARRR: 0.370, 95%CI (0.199, 0.66)], having TB treatment supporter [ARRR: 0.022, 95%CI (0.002, 0.231)] & higher degree of drug resistance. Furthermore, unfavorable treatment outcome was found to be higher xvi among those who were older age ARRR: 1.047, 95%CI (1.024, 1.072) and lesser among patients with history of hypokalemia ARRR: 0.512, 95%CI (0.280, 0.939). Conclusion: Responsible organizations and individuals should focus on patients from rural areas and old patients, and provide supports to reduce the risk of unknown and unfavorable multidrug resistant tuberculosis intensive phase treatment outcome.