Pretreatment attrition and treatment initiation delay among rifampicin-resistant tuberculosis patients in Lagos, Nigeria: a retrospective cohort study.

BACKGROUND: Assessing associated factors of pretreatment attrition and treatment delays among rifampicin-resistant tuberculosis (RR-TB) patients could serve as a valuable tool to control and prevent its community spread. We assessed the factors associated with pretreatment attrition and treatment initiation delays among RR-TB patients in Lagos, Nigeria. METHODS: A retrospective cohort study was conducted involving secondary program data of RR-TB patients diagnosed using the Xpert MTB/RIF assay and initiated on treatment between 1 January 2015 and 31 December 2017 in Lagos. Factors associated with pretreatment attrition and treatment initiation delay were determined using logistic regression. RESULTS: Of the 606 RR-TB patients diagnosed during the review period, 135 (22.3%) had pretreatment attrition. Previously treated TB patients had a 2.4-fold greater chance of having pretreatment attrition than new RR-TB patients (adjusted odds ratio 2.4 [95% confidence interval 1.2-5.0]). The median time to treatment initiation was 29 d (interquartile range [IQR] 18-49). It was longer for new RR-TB patients (49 d [IQR 36-59]) than previously treated TB patients (28 d [IQR 17-44]). A total of 47% had long treatment delays. Being newly diagnosed with RR-TB was associated with long treatment delays. CONCLUSIONS: The pretreatment attrition rate and proportion of RR-TB patients with treatment delays were high. Pragmatic approaches to address the high pretreatment attrition and treatment delays in Lagos, Nigeria, are urgently needed.

The pattern of comorbidity and its prevalence among drug-resistant tuberculosis patients at treatment initiation in Lagos, Nigeria.

BACKGROUND: Multimorbidity is increasingly being recognized as a serious public health concern in the control of both drug-susceptible and drug-resistant tuberculosis (DR-TB). This study assessed the pattern of comorbidities and their prevalence in DR-TB patients at treatment initiation in Lagos, Nigeria. METHODS: A cross-sectional study was conducted. The baseline laboratory records (human immunodeficiency virus [HIV] status, fasting blood sugar, audiometry, thyroid function tests, serum electrolyte, haemoglobin level and pregnancy test) of DR-TB patients initiated on treatment in Lagos, Nigeria between 1 August 2014 and 31 March 2017 were reviewed. RESULTS: A total of 565 DR-TB patients' laboratory records were reviewed, of which 397 (70.3%) had comorbidities. The proportion with one, two, three and four comorbidities was 60.2%, 29.7%, 8.1% and 2.0%, respectively. Anaemia was the most common (48.1%) comorbid condition, while anaemia and hypokalaemia (7.3%), anaemia and hypothyroidism (6.5%) and anaemia and HIV (5%) were most common among patients with more than one comorbid condition. DR-TB patients with comorbidity were significantly older (34.8±12.3 y) than those without comorbidity (32.0±12.8 y) (p=0.038). Of the 176 females in the reproductive age group, 8 (4.5%) were pregnant at baseline. CONCLUSIONS: The prevalence of comorbidity among DR-TB patients was high. There is a need for the national TB program to expand its DR-TB council of experts and also integrate reproductive health services into DR-TB management in Nigeria.