Tuberculosis retreatment 'others' in comparison with classical retreatment cases; a retrospective cohort review.
BACKGROUND
Many of the countries in sub-Saharan Africa are still largely dependent on microscopy as the mainstay for diagnosis of tuberculosis (TB) including patients with previous history of TB treatment. The available guidance in management of TB retreatment cases is focused on bacteriologically confirmed TB retreatment cases leaving out those classified as retreatment 'others'. Retreatment 'others' refer to all TB cases who were previously treated but with unknown outcome of that previous treatment or who have returned to treatment with bacteriologically negative pulmonary or extra-pulmonary TB. This study was conducted in 11 regional referral hospitals (RRHs) serving high burden TB districts in Uganda to determine the profile and treatment success of TB retreatment 'others' in comparison with the classical retreatment cases.


METHODS
A retrospective cohort review of routinely collected National TB and Leprosy Program (NTLP) facility data from 1 January to 31 December 2010. This study uses the term classical retreatment cases to refer to a combined group of bacteriologically confirmed relapse, return after failure and return after loss to follow-up cases as a distinct group from retreatment 'others'. Distribution of categorical characteristics were compared using Chi-squared test for difference between proportions. The log likelihood ratio test was used to assess the independent contribution of type of retreatment, human immunodeficiency virus (HIV) status, age group and sex to the models.


RESULTS
Of the 6244 TB cases registered at the study sites, 733 (11.7%) were retreatment cases. Retreatment 'others' constituted 45.5% of retreatment cases. Co-infection with HIV was higher among retreatment 'others' (70.9%) than classical retreatment cases (53.5%). Treatment was successful in 410 (56.2%) retreatment cases. Retreatment 'others' were associated with reduced odds of success (AOR = 0.44, 95% CI 0.22,0.88) compared to classical cases. Lost to follow up was the commonest adverse outcome (38% of adverse outcomes) in all retreatment cases. Type of retreatment case, HIV status, and age were independently associated with treatment success.


CONCLUSIONS
TB retreatment 'others' constitute a significant proportion of retreatment cases, with higher HIV prevalence and worse treatment success. There is need to review the diagnosis and management of retreatment 'others'.
Track Tuberculosis Activity Project-Management Sciences for Health, Plot no. 15, Princess Anne Drive Bugolobi, P.O. Box 71419, Kampala, Uganda. marygmudiope@gmail.com.
Mary G
MG
Nabukenya-Mudiope
German Leprosy and Tuberculosis Relief Association, Kampala, Uganda. kawumahjs@gmail.com.
Herman Joseph
HJ
Kawuma
Public Health and Tuberculosis Consultancy, Tilburg, The Netherlands. mbrouwer@phtbconsult.org.
Miranda
M
Brouwer
Uganda AIDS Commission, Kampala, Uganda. pmudiope@gmail.com.
Peter
P
Mudiope
London School of Hygiene and Tropical Medicine, London, United Kingdom. Anna.Vassall@lshtm.ac.uk.
Anna
A
Vassall
D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
D000995:Antitubercular Agents