Tuberculosis Treatment Outcomes in Brazil: Different Predictors for Each Type of Unsuccessful Outcome.

Autor:	Ridolfi F; Instituto Nacional de Infectologia Evandro Chagas (INI), Fiocruz, Rio de Janeiro, Brazil., Peetluk L; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Amorim G; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA., Turner M; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Figueiredo M; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Cordeiro-Santos M; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT), Manaus, Brazil.; Universidade do Estado do Amazonas (UEA), Manaus, Brazil., Cavalcante S; Clínica de Família Rinaldo Delamare, Rocinha, Rio de Janeiro, Brazil.; Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, Brazil., Kritski A; Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, Brazil., Durovni B; Centro de Estudos Estratégicos, Fiocruz, Rio de Janeiro, Brazil., Andrade B; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.; Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.; Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil.; Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil.; Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil., Sterling TR; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Rolla V; Instituto Nacional de Infectologia Evandro Chagas (INI), Fiocruz, Rio de Janeiro, Brazil.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Feb 08; Vol. 76 (3), pp. e930-e937.
DOI:	10.1093/cid/ciac541
Abstrakt:	Background: Successful tuberculosis (TB) treatment is necessary for disease control. The World Health Organization (WHO) has a target TB treatment success rate of ≥90%. We assessed whether the different types of unfavorable TB treatment outcome had different predictors. Methods: Using data from Regional Prospective Observational Research for Tuberculosis-Brazil, we evaluated biological and behavioral factors associated with each component of unsuccessful TB outcomes, recently updated by WHO (death, loss to follow-up [LTFU], and treatment failure). We included culture-confirmed, drug-susceptible, pulmonary TB participants receiving standard treatment in 2015-2019. Multinomial logistic regression models with inverse probability weighting were used to evaluate the distinct determinants of each unsuccessful outcome. Results: Of 915 participants included, 727 (79%) were successfully treated, 118 (13%) were LTFU, 44 (5%) had treatment failure, and 26 (3%) died. LTFU was associated with current drug-use (adjusted odds ratio [aOR] = 5.3; 95% confidence interval [CI], 3.0-9.4), current tobacco use (aOR = 2.9; 95% CI, 1.7-4.9), and being a person with HIV (PWH) (aOR = 2.0; 95% CI, 1.1-3.5). Treatment failure was associated with PWH (aOR = 2.7; 95% CI, 1.2-6.2) and having diabetes (aOR = 2.2; 95% CI, 1.1-4.4). Death was associated with anemia (aOR = 5.3; 95% CI, 1.4-19.7), diabetes (aOR = 3.1; 95% CI, 1.4-6.7), and PWH (aOR = 3.9; 95% CI, 1.3-11.4). Direct observed therapy was protective for treatment failure (aOR = 0.5; 95% CI, .3-.9) and death (aOR = 0.5; 95% CI, .2-1.0). Conclusions: The treatment success rate was below the WHO target. Behavioral factors were most associated with LTFU, whereas clinical comorbidities were correlated with treatment failure and death. Because determinants of unsuccessful outcomes are distinct, different intervention strategies may be needed to improve TB outcomes. Competing Interests: Potential conflicts of interest. The authors do not have an association that might pose a conflict of interest. V. C. R. reports grants or contracts outside of the submitted work from TB Alliance for Drug Development (NC-008), Impacto da COVID-19 Nas Manifestações Clínicas, Diagnóstico, Desfecho Do Tratamento e Resposta Imune para Tuberculose Pulmonar (440933/2020-0 to CNPq account (not to self), Associative BRICS Research in COVID-19 and Tuberculosis (ABRICOT) (G-202105-67821 to Fiotec), RePORT International Data Harmonization (R-202108-68053 to Fiotec), Transcriptional Signature of TB in advanced HIV (DAA3-18-64313 to Fiotec), Predictors of Resistance Emergence Evaluation in Multidrug-resistant Tuberculosis patients on Treatment – PREEMPT (R01AI134430), Caribbean, Central, and South America network for HIV Epidemiology (CCASAnet) (U01AI069923 to Fiotec), and immunogenetic predictors of active and incipient TB in HIV-negative and -positive close TB contacts (R01AI147765 to Fiotec); consulting fees paid to self from ONU-OMS Country review for HIV response Myanmar; payment or honoraria paid to self from GLAXOSMITHKLINE BRASIL LTDA, Qiagen (Infecto Rio Conference), and virology education (Infecto Rio Conference); payment directly to the conference for registration for ViiV 18 European AIDS conference; and payment directly to self from NIH Data Safety Monitoring Board. (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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