title: Factors Associated with Unfavorable Treatment Outcomes in New and Previously Treated TB Patients in Uzbekistan: A Five Year Countrywide Study.
abstract: BACKGROUND
  TB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures) and describe their associations with socio-demographic and clinical factors.
  
  
  METHODS
  A countrywide retrospective cohort study of all new and previously treated TB patients registered in the National Tuberculosis programme between January 2006 and December 2010.
  
  
  RESULTS
  Among 107,380 registered patients, 67% were adults, with smaller proportions of children (10%), adolescents (4%) and elderly patients (19%). Sixty per cent were male, 66% lived in rural areas, 1% were HIV-infected and 1% had a history of imprisonment. Pulmonary TB (PTB) was present in 77%, of which 43% were smear-positive and 53% were smear-negative. Overall, 83% of patients were successfully treated, 6% died, 6% were lost-to-follow-up, 3% failed treatment and 2% transferred out. Factors associated with death included being above 55 years of age, HIV-positive, sputum smear positive, previously treated, jobless and living in certain provinces. Factors associated with lost-to-follow-up were being male, previously treated, jobless, living in an urban area, and living in certain provinces. Having smear-positive PTB, being an adolescent, being urban population, being HIV-negative, previously treated, jobless and residing in particular provinces were associated with treatment failure.
  
  
  CONCLUSIONS
  Overall, 83% treatment success rate was achieved. However, our study findings highlight the need to improve TB services for certain vulnerable groups and in specific areas of the country. They also emphasize the need to develop unified monitoring and evaluation tools for drug-susceptible and drug-resistant TB, and call for better TB surveillance and coordination between provinces and neighbouring countries.
authors.affiliation: World Health Organization country office in Tashkent, Tashkent, Uzbekistan.
authors.forename: Jamshid
authors.initials: J
authors.lastname: Gadoev
authors.affiliation: State Post Graduate Institute of Medical Education, Tashkent, Uzbekistan.
authors.forename: Damin
authors.initials: D
authors.lastname: Asadov
authors.affiliation: Republican Specialized TB center, Tashkent, Uzbekistan.
authors.forename: Mirzagolib
authors.initials: M
authors.lastname: Tillashaykhov
authors.affiliation: Medecins Sans Frontieres (MSF), Operational Center Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Katie
authors.initials: K
authors.lastname: Tayler-Smith
authors.affiliation: Medecins Sans Frontieres (MSF), Operational Center Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.affiliation: WHO Regional Office for Europe, TBM department, Copenhagen, Denmark.
authors.forename: Andrei
authors.initials: A
authors.lastname: Dadu
authors.affiliation: WHO Regional Office for Europe, TBM department, Copenhagen, Denmark.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: de Colombani
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway.
authors.forename: Sven
authors.initials: S
authors.lastname: Gudmund Hinderaker
authors.affiliation: Tashkent Medical Academy, Tashkent, Uzbekistan.
authors.forename: Nargiza
authors.initials: N
authors.lastname: Parpieva
authors.affiliation: World Health Organization country office in Tashkent, Tashkent, Uzbekistan.
authors.forename: Dilrabo
authors.initials: D
authors.lastname: Ulmasova
authors.affiliation: Republican DOTS center, Tashkent, Uzbekistan.
authors.forename: Avazbek
authors.initials: A
authors.lastname: Jalolov
authors.affiliation: Nukus branch of Tashkent State Pediatric Institute, Nukus, Karakalpakstan.
authors.forename: Atadjan
authors.initials: A
authors.lastname: Hamraev
authors.affiliation: Medecins Sans Frontieres (MSF), Operational Center Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Engy
authors.initials: E
authors.lastname: Ali
authors.affiliation: WHO Regional Office for Europe, TBM department, Copenhagen, Denmark.
authors.forename: Martin van den
authors.initials: Mv
authors.lastname: Boom
authors.affiliation: World Health Organization country office in Tashkent, Tashkent, Uzbekistan.
authors.forename: Asmus
authors.initials: A
authors.lastname: Hammerich
authors.affiliation: World Health Organization country office in Tashkent, Tashkent, Uzbekistan.
authors.forename: Ogtay
authors.initials: O
authors.lastname: Gozalov
authors.affiliation: WHO Regional Office for Europe, TBM department, Copenhagen, Denmark.
authors.forename: Masoud
authors.initials: M
authors.lastname: Dara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D060085:Coinfection; D005260:Female; D015658:HIV Infections; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D012042:Registries; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology* / Q000628:therapy; D014610:Uzbekistan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents