Sulaiman Lakoh1, Darlinda F Jiba2, Olukemi Adekanmbi3, Eva Poveda4, Foday Sahr5, Gibrilla F Deen6, Lynda M Foray7, Wadzani Gashau8, Christopher J Hoffmann9, Robert A Salata10, George A Yendewa11. 1. College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone. Electronic address: lakoh2009@gmail.com. 2. Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone. 3. College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University College Hospital, Ibadan, Nigeria. 4. Group of Virology and Pathogenesis, Galicia Sur Health Research Institute, Complexo Hospitalario Universitario de Vigo, SERGAS-Vigo, Vigo, Spain. 5. College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone. 6. College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone. 7. National TB and Leprosy Control Programme, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone. 8. College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria. 9. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 10. Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. 11. Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Abstract
OBJECTIVE: To assess the diagnosis, treatment outcomes, and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. METHODS: A retrospective study was conducted of adult TB patients aged ≥15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. RESULTS: Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n=1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%), and had pulmonary TB (96.3%). Treatment outcomes were as follows: 29.0% cured, 29.0% completed, 0.5% treatment failure, 24.2% lost to follow-up, 12.8% transferred/not evaluated, and 4.5% died. The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older (adjusted odds ratio 3.48, 95% confidence interval 1.15-10.56; p=0.027) and HIV-positive status (adjusted odds ratio 3.50, 95% confidence interval 1.72-7.12; p=0.001) were independent predictors of mortality. CONCLUSIONS: Suboptimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets.
OBJECTIVE: To assess the diagnosis, treatment outcomes, and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. METHODS: A retrospective study was conducted of adult TB patients aged ≥15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. RESULTS: Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n=1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%), and had pulmonary TB (96.3%). Treatment outcomes were as follows: 29.0% cured, 29.0% completed, 0.5% treatment failure, 24.2% lost to follow-up, 12.8% transferred/not evaluated, and 4.5% died. The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older (adjusted odds ratio 3.48, 95% confidence interval 1.15-10.56; p=0.027) and HIV-positive status (adjusted odds ratio 3.50, 95% confidence interval 1.72-7.12; p=0.001) were independent predictors of mortality. CONCLUSIONS: Suboptimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets.
Authors: George A Yendewa; Sulaiman Lakoh; Darlinda F Jiba; Sahr A Yendewa; Umu Barrie; Gibrilla F Deen; Mohamed Samai; Jeffrey M Jacobson; Foday Sahr; Robert A Salata Journal: J Clin Med Date: 2022-06-16 Impact factor: 4.964