National profile and treatment outcomes of adult smear-negative pulmonary TB patients in Benin.
BACKGROUND
In Benin, patients with smear-negative pulmonary TB (SNPTB) are of low priority in the National Tuberculosis Programme (NTP) and little is known about their profile or treatment outcomes.


METHODS
A retrospective cohort study was carried out to determine characteristics and treatment outcomes in all adults registered with SNPTB in 2009. Findings were compared with patients with new smear-positive pulmonary tuberculosis (PTB) diagnosed in the same period.


RESULTS
Of 3140 patients with PTB, 273 (8.7%) had SNPTB, with higher rates in northern and southwestern regions. SNPTB was associated with female gender, older age and HIV-positive status (p<0.01). Patients with SNPTB had a higher proportion of unsuccessful treatment outcomes compared with smear-positive PTB owing to death and loss to follow-up (LFU) (p<0.01). The region with the capital city had the highest rate of LFU. Differences in unsuccessful outcomes between SNPTB and smear-positive PTB were more apparent in persons who were HIV-negative, and among HIV-positives not on antiretroviral treatment.


CONCLUSIONS
In Benin, treatment outcomes of SNPTB patients were inferior to those with smear-positive PTB, with LFU being a major problem. The Benin NTP needs to better address the problem of patients with SNPTB in terms of monitoring and reporting, treatment management including that associated with HIV care, and reducing LFU.
National TB Programme, Cotonou, Benin.
Serge
S
Ade
Anthony D
AD
Harries
Arnaud
A
Trébucq
Sven Gudmund
SG
Hinderaker
Gabriel
G
Adè
Gildas
G
Agodokpessi
Dissou
D
Affolabi
Sévérin
S
Anagonou
D000293:Adolescent; D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001541:Benin / Q000453:epidemiology; D015331:Cohort Studies; D017281:Cost of Illness; D005189:False Positive Reactions; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D055815:Young Adult
D000995:Antitubercular Agents
Benin; HIV; Loss to follow-up; Smear-negative pulmonary TB; Treatment outcome