Effects of Comorbid Non-Communicable Diseases on Tuberculosis Treatment Outcomes in Ethiopia: A Retrospective Cohort Study
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Date
2024-02-13
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Addis Ababa University
Abstract
Background: The intersection of tuberculosis (TB) and non-communicable diseases (NCDs) presents a major challenge in achieving global health targets, including the WHO’s End TB 2030 strategy. In countries like Ethiopia where the TB burden is particularly high, the impact of NCDs on TB treatment remains insufficiently explored, limiting the development of informed interventions. Therefore, this study aimed to assess the effect of comorbid NCDs on TB treatment outcomes and identify underlying factors in Ethiopia.
Methods: This was a retrospective cohort study that utilized secondary data from the EXIT TB project - an evidence-based, multiple-focus integrated intensified TB screening package. Participants were individuals with acute respiratory symptoms seeking outpatient care at four healthcare facilities in Ethiopia selected using stratified random sampling that account for urban and rural differences. Of these, all patients confirmed positive for TB and tested for NCDs were included. The patients were divided into two exposure groups: the exposed group, consisting of patients diagnosed with TB and one or more NCDs, and the non-exposed group, consisting of patients diagnosed with TB but without any NCDs. Their data were extracted from the EXIT-TB database, focusing on four key categories: sociodemographic variables, TB diagnosis and risk factor, NCD diagnosis, and TB treatment outcomes, classified as cured, treatment completed, treatment failure, loss to follow-up, transferred out, not assessed and death. The data were analyzed using SPSS version 20. A Chi-square (X2) test was used to compare the baseline and clinical characteristics between the NCD-TB comorbid and TB-only patients groups, with a significance level of p≤0.05. Multiple logistic regression was used to investigate the association between independent and dependent variables.
Results: A total of 356 participants were included in the analysis, with 198 (55.6%) men, and the largest age group was between 15 and 30 years. The overall treatment success rate was 95.2%, with an unsuccessful treatment outcome of 4.8%. Patients with TB-NCD comorbidities had a higher rate of unsuccessful treatment outcome, with 27.3% for those with TB-NCD comorbidity, compared to 4.0 % for those with TB only, resulting in an incident rate ratio of 6.8 (95% CI 2.4-19.5). Male gender (AOR=4.4 (CI 1.1-18.4)) and NCDs (AOR=8.9(CI (1.5 52.9)) were identified as significant risk factors for unsuccessful treatment outcomes.
Conclusion: The findings show that the incidence of unsuccessful treatment outcomes was nearly seven times higher in patients with TB-NCDs comorbidity compared to TB-only. This study underscores the importance of screening for and addressing NCD comorbidities in TB management. Healthcare systems should prioritize integrating TB care with the management of comorbid conditions to ensure patients receive comprehensive and coordinated treatment and better treatment outcomes.
Keywords: TB, NCD, Comorbidity, Tuberculosis, Non communicable diseases
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TB NCD Comorbidity Tuberculosis Non communicable diseases