Predictors of treatment success among patients with drug resistant Tuberculosis in Namibia
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
University of Namibia
Abstract
Drug resistant tuberculosis (DR-TB) is a considerable barrier to ending TB globally. In Namibia, the burden of DR-TB, among new and previously treated TB patients is estimated at 3.3% and 18% respectively. The study aimed to determine predictors and patterns of treatment success rates (TSR) among patients with DR-TB in Namibia, to inform national TB program and guidelines. A nationwide case-control study of predictors of DR-TB TSR utilized patient data in the national TB register over 5 years period (201-2019). The data on treatment outcomes, patient socio-demographic, clinical and treatment, and TB programme covariates were analysed in SPSS v22. TSR patterns and crude predictors were determined using descriptive and univariate analysis respectively. Adjusted odd ratios (aOR) (adjusted for the confounders abuse of alcohol and time to treatment) were determined to identify independent predictors of TSR in DR-TB, using multivariate logistic regression. Of the 1494 analysed record 56.3% (n=841) were for males, the mean age was 35.6±14.2 years, and 8.3% had HIV coinfection. The overall TSR was 66.5% (n=994). Prevalent adverse drug reactions (ADRs) were ototoxicity/tinnitus (n=1.8%, 27), vomiting (0.6 %, n=9), 0.4% for joint pains and peripheral neuropathy, 3% for renal impairment, visual disturbance and skin rash. The independent socio-demographic predictors of treatment success were female sex (aOR=0.6, 95%CI:0.34, 0.89; p=0.015), young age <5 years (aOR=0.1, 95%CI:0.0007, 0.421; p=0.005) and 5-14years (aOR=0.0, 95%CI:0.002,0.269; p=0.002), and Namibian citizenship (aOR=0.3; 95%CI: 0.089,0.961; p=0.043). Clinical predictors were; baseline mono-resistance (aOR=7.6, 95%CI:1.427,40.631; p=0.018), and bilateral pulmonary forms (aOR=0.2, 95%CI:0.057,0.498; p=0.001). Whilst TSRs have improved, they remain below global targets and vary by type, regions and patient populations. There is need to individualize DR-TB treatment with targeted at males, older patients, expats, baseline resistance to more than one drug and bilateral pulmonary disease administer using a community-based Directly Observed Treatment (DOTS) approach.
Description
A mini thesis submitted in partial fulfilment of the requirements for the degree of Masters of Pharmacy (Clinical Pharmacy)
Keywords
Directly Observed Treatment (DOTS) approach, Pulmonary disease, Drug resistant tuberculosis, Tuberculosis