Author(s): Hamusse SD, Demissie M, Teshome D, Lindtjrn B
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Abstract BACKGROUND: Directly Observed Treatment Short course (DOTS) strategy is aimed at diagnosing 70\% of infectious tuberculosis (TB) and curing 85\% of it. Arsi Zone of Ethiopia piloted DOTS strategy in 1992. Since then, the trend in treatment outcomes in general and at district-level in particular has not been assessed. The aim of this study was to analyse the trend in TB treatment outcomes and audit district-level treatment outcomes in the 25 districts of Arsi Zone. DESIGN: A retrospective cohort study design was employed to audit pulmonary smear-positive (PTB + ) patients registered between 1997 and 2011. Demographic and related data were collected from the TB unit registers between January and March 2013. The 15-year trend in treatment outcomes among PTB+ patients and district-level treatment outcomes was computed. RESULTS: From 14,221 evaluated PTB+ cases, 11,888 (83.6\%) were successfully treated. The treatment success rate (TSR) varied from 69.3 to 92.5\%, defaulter rate from 2.5 to 21.6\%, death rate from 1.6 to 11.1\%, and failure rate from 0 to 3.6\% across the 25 districts of the zone. The trend in TSR increased from 61 to 91\% with the increase of population DOTS coverage from 18 to 70\%. There was a declining trend in defaulter rate from 29.9 to 2.1\% and death rate from 8.8 to 5.4\% over 15 years. Patients aged 25-49 years (Adjusted Odd Ratio (AOR), 0.23; 95\% CI: 0.21-0.26) and ≥50 years (AOR, 0.43; 95\% CI: 0.32-0.59), re-treatment cases (AOR, 0.61; 0.41, 0.67), and TB/HIV co-infection cases (AOR, 0.45; 95\% CI: 0.31-0.53) were associated with unsuccessful treatment outcomes. CONCLUSIONS: DOTS expansion and improving population DOTS coverage in Arsi has led to a significant increase in treatment success and decrease in death and defaulter rates. However, there is a major variation in treatment outcomes across the 25 districts of the zone, so district-specific intervention strategy needs to be considered. The low TSR among re-treatment cases might be due to the high rate of MDR-TB among this group, and the issue needs to be further investigated to identify the extent of the problem.
This article was published in Glob Health Action
and referenced in Mycobacterial Diseases