Tuberculosis yield among contacts of non-pulmonary bacteriologically confirmed index TB patients in the urban setting of central Uganda.

BACKGROUND: The World Health Organization (WHO) recommends systematic and active investigation of TB contacts. However, lower priority is given to contact investigation among other non-pulmonary bacteriologically confirmed (PBC) cases; it thus contributes to the scarce information on the yield of TB among contacts of index TB patients without microbiological confirmation (non-PBC patients). This study therefore aimed at establishing the yield of TB among contacts of PBC and non-PBC index TB patients in the urban setting of central Uganda. METHODS: We abstracted data from the Uganda national TB contact investigation registers present at 48 health facilities for the period January 2018 to August 2020. The screening yield for both PBC and non-PBC, timing of TB diagnosis among contacts were determined. Logistic regression was used to examine predictors for diagnosing contacts as non PBC TB patients. RESULTS: From January 2018 to August 2020, 234 persons were diagnosed with TB from a total of 14,275 contacts traced for both PBC and non-PBC TB index patients at 48 facilities. Of these, 100(42.7%) were contacts of non-PBC index patients. TB screening yield was higher among contacts of non PBC 100(2.0%) compared to 134(1.4%) among contacts of PBC index patients. For both groups, over 80% of their contacts were diagnosed with TB within 3 months from the day of TB treatment start of the index case. On multivariate logistic regression the only predictor for diagnosing contacts as non PBC TB patients was age under15 years (adjusted odds ratio [aOR] 7.53, 95% CI [3.27-17.3] p = <0.05). CONCLUSION: The yield of TB among contacts of non-PBC index case is nearly the same for contacts of PBC index cases and most contacts were diagnosed with TB disease during the intensive TB treatment phase of the index case. There was no association between the type of TB (PBC, non-PBC) disease diagnosed in the contacts, and that of index TB patients. To improve TB case-finding, emphasis should be placed on contact investigation for household and close contacts of all other index cases with pulmonary tuberculosis regardless of whether PBC or non-PBC during the intensive phase of treatment.

Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study.

BACKGROUND: The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. However, mortality due to multidrug-resistant tuberculosis (MDR-TB) remains particularly high. Globally, almost 20% of patients started on MDR-TB treatment die during the course of treatment every year. We set out to examine the risk factors for mortality among a cohort of patients diagnosed with MDR-TB in Uganda. METHODS: We conducted a case-control study nested within the national MDR-TB cohort. We defined cases as patients who died from any cause during the course of MDR-TB treatment. We selected two controls for each case from patients alive and on MDR-TB treatment at the time that the death occurred (incidence-density sampling). We matched the cases and controls on health facility at which they were receiving care. We performed conditional logistic regression to identify the risk factors for mortality. RESULTS: Data from 198 patients (66 cases and 132 controls) started on MDR-TB treatment from January 1 to December 31, 2016, was analyzed for this study. Cases were similar to controls in age/sex distribution, occupation and history of TB treatment. However, cases were more likely to be HIV infected while controls were more likely to have attained secondary level education. On multivariate regression analysis, co-infection with HIV (aOR 1.9, 95% CI [1.1-4.92] p = 0.05); non-adherence to MDR-TB treatment (aOR 1.92, 95% CI [1.02-4.83] p = 0.04); age over 50 years (aOR 3.04, 95% CI [1.13-8.20] p = 0.03); and having no education (aOR 3.61, 95% CI [1.1-10.4] p = 0.03) were associated with MDR-TB mortality. CONCLUSION: To mitigate MDR-TB mortality, attention must be paid to provision of social support particularly for older persons on MDR-TB treatment. In addition, interventions that support treatment adherence and promote early detection and management of TB among HIV infected persons should also be emphasized.