Treatment Outcome and Its Associated Factors Among Multidrug-resistant (Mdr-tb) Pulmonary Tuberculosis Patients in Kenya- a Retrospective Cohort Study

Abstract

Introduction: Multidrug resistant tuberculosis is described as tuberculosis caused by a genetic variant of Mycobacterium Tuberculosis which is resistant to most potent anti-TB drugs i.e. isoniazid and rifampicin. Kenya is classified among the 30 countries with a high burden of tuberculosis. TB is also among the leading causes of mortality in Kenya. MDR-TB cases continue to rise both globally and in Kenya. In 2016, 445 cases of MDR-TB were diagnosed in Kenya. Treatment success rate decreased from 84% in 2013 to 74% in the 2014 cohort, with a mortality rate of 17% in 2014. Objective: The objective of this study was to analyze the treatment outcome and associated factors for MDR-TB cases enrolled and completed treatment from 2016-2018. Methodology: The study was a retrospective cohort study for MDR-TB patients enrolled and completed treatment between 2016 and 2018 in Kenya. The data was obtained from TIBU; an electronic TB case based system that is used to collect routine TB surveillance data in Kenya. A patient was included in the study if he/she was enrolled for treatment between 1st January 2016 and 30th Oct 2018 and the outcome of the treatment assigned The data was exported to excel for preliminary cleaning then exported to Stata 13 for analysis. Treatment outcomes were analyzed and presented in terms of percentages. Odds ratio were calculated to determine the factors that are associated with the observed outcome. Univariate analysis was conducted to summarize the data while bivariate data was used to check for association. Logistic regression model was fitted for the statistically significant variable at multivariate analysis level. Results: the results were based on 126 MDR-TB cases. Nairobi County was leading in number of MDR-TB cases. Out of the total number of patients who died 69% were HIV positive. 83.3% of the patients in the study were aged above 24 years. In addition, there were more malels, 58% compared to female 42%.The study found a treatment success rate of 71%, mortality rate of 20%, 2% failed treatment while 6% were lost to LTFU. However, the study found a cure rate of 40% and therefore 31% of the patients did not undertake a sputum smear microscopy test to confirm absence of TB after completion of treatment. The study found that patients who were HIV negative and their BMI was normal (OR=0.03, P-value=0.021) had significantly better treatment success rate. Most of the data analyzed was reported from public facilities with only 8 clients reported from private and FBO. All the patients in the study were tested for HIV. Conclusion: HIV status and normal BMI are predictors of successful treatment outcome for MDR-TB patients. Private facilities should be capacity build to manage MDR TB cases. In addition, all clients who completes treatment should undergo smear/culture test at the last month of treatment to ascertain cure.