학술논문
Tuberculosis Treatment Outcomes in Brazil: Different Predictors for Each Type of Unsuccessful Outcome.
Document Type
Article
Author
Ridolfi, Felipe; Peetluk, Lauren; Amorim, Gustavo; Turner, Megan; Figueiredo, Marina; Cordeiro-Santos, Marcelo; Cavalcante, Solange; Kritski, Afrânio; Durovni, Betina; Andrade, Bruno; Sterling, Timothy R; Rolla, Valeria; Consortium, for the Regional Prospective Observational Research in Tuberculosis (RePORT)–Brazil
Source
Subject
*TUBERCULOSIS mortality
*DRUG therapy for tuberculosis
*PATIENT aftercare
*HIV infections
*RESEARCH
*SUBSTANCE abuse
*CONFIDENCE intervals
*CHEST X rays
*MULTIPLE regression analysis
*SELF-evaluation
*SPUTUM
*DIABETES
*TREATMENT effectiveness
*TREATMENT failure
*LEANNESS
*ANTITUBERCULAR agents
*DESCRIPTIVE statistics
*ANEMIA
*DRUGS
*ALCOHOL drinking
*QUESTIONNAIRES
*RESEARCH funding
*PATIENT compliance
*STATISTICAL models
*SMOKING
*ODDS ratio
*DATA analysis software
*LONGITUDINAL method
*EVALUATION
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
1058-4838
Abstract
Background Successful tuberculosis (TB) treatment is necessary for disease control. The World Health Organization (WHO) has a target TB treatment success rate of ≥90%. We assessed whether the different types of unfavorable TB treatment outcome had different predictors. Methods Using data from Regional Prospective Observational Research for Tuberculosis-Brazil, we evaluated biological and behavioral factors associated with each component of unsuccessful TB outcomes, recently updated by WHO (death, loss to follow-up [LTFU], and treatment failure). We included culture-confirmed, drug-susceptible, pulmonary TB participants receiving standard treatment in 2015–2019. Multinomial logistic regression models with inverse probability weighting were used to evaluate the distinct determinants of each unsuccessful outcome. Results Of 915 participants included, 727 (79%) were successfully treated, 118 (13%) were LTFU, 44 (5%) had treatment failure, and 26 (3%) died. LTFU was associated with current drug-use (adjusted odds ratio [aOR] = 5.3; 95% confidence interval [CI], 3.0–9.4), current tobacco use (aOR = 2.9; 95% CI, 1.7–4.9), and being a person with HIV (PWH) (aOR = 2.0; 95% CI, 1.1–3.5). Treatment failure was associated with PWH (aOR = 2.7; 95% CI, 1.2–6.2) and having diabetes (aOR = 2.2; 95% CI, 1.1–4.4). Death was associated with anemia (aOR = 5.3; 95% CI, 1.4–19.7), diabetes (aOR = 3.1; 95% CI, 1.4–6.7), and PWH (aOR = 3.9; 95% CI, 1.3–11.4). Direct observed therapy was protective for treatment failure (aOR = 0.5; 95% CI,.3–.9) and death (aOR = 0.5; 95% CI,.2–1.0). Conclusions The treatment success rate was below the WHO target. Behavioral factors were most associated with LTFU, whereas clinical comorbidities were correlated with treatment failure and death. Because determinants of unsuccessful outcomes are distinct, different intervention strategies may be needed to improve TB outcomes. [ABSTRACT FROM AUTHOR]