Predictors of tuberculosis treatment outcomes in Antananarivo: a retrospective cohort study.

Introduction: Tuberculosis (TB) is a global public health issue, affecting Africa and Madagascar. Adverse outcomes following ineffective treatment are common. Previous studies conducted in similar settings have not adequately accounted for confounding factors. The objective of this study is to identify predictive factors that are associated with tuberculosis treatment outcomes in Madagascar.

Methods: a retrospective cohort study was conducted using registries of 628 outpatients with tuberculosis at the Analakely Hospital (CHUSSPA) in 2019. Univariate and multivariate logistic regression analyses were performed.

Results: the study included 628 patients with a mean age of 37.19 ± 15.86 years and a sex ratio of 1.57. These patients were followed up for a total of 2886 person-months. Out of the 628, 517 achieved treatment success, while 31 patients died and 31 discontinued their treatment. The rates of treatment success, death, failure, and default were 82.3%, 4.9%, 0.2%, and 8.3% respectively. Female gender was found to be a predictor of treatment success area of responsibility adjusted odds ratio(AOR 1.67 [1.07-2.66]; p=0.026). Smear-negative pulmonary tuberculosis (SNPTB) was associated with a lower likelihood of treatment success (AOR 0.38 [0.23-0.65]; p<0.001) and was a common factor for default (AOR 3.17 [1.60-6.21]; p=0.001) and death (AOR=8.03 [3.01-23.72; p<0.001]). Extra-pulmonary TB was identified as a predictor of death (AOR 5.15 [1.99-14.95]; p=0.001).

Conclusion: the tuberculosis treatment indicators in this center have not yet met national and global targets. It is necessary to focus on early diagnosis, improving education, and implementing rigorous follow-up procedures for patients at high risk of adverse outcomes (SNPTB and extra-pulmonary tuberculosis(EPTB).