TITLE:
Identifying Factors that Affect the Probability of Being Cured from MDR-TB Disease, KwaZulu-Natal, South Africa: A Competing Risks Analysis
AUTHORS:
Sizwe Vincent Mbona, Henry Mwambi, Retius Chifurira
KEYWORDS:
Competing Risks, MDR-TB, South Africa
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.10 No.1,
February
11,
2022
ABSTRACT: Setting: Four
decentralised sites are located in rural areas and
one centralised hospital in KwaZulu-Natal province, South Africa. Objective: To analyse risk factors associated with multidrug-resistant
tuberculosis (MDR-TB) using competing risks analysis. Understanding
factors associated with MDR-TB and obtaining valid parameter estimates could
help in designing control and intervention strategies to lower TB mortality. Method: A prospective study was performed using a competing risk analysis in patients
receiving treatment for MDR-TB. The study focused on 1542 patients (aged 18
years and older) who were diagnosed of MDR-TB between July 2008 and June 2010.
Time to cure MDR-TB was used as the dependent variable and time to death was
the competing risk event. Results: The Fine-Gray regression model indicated that baseline
weight was highly significant with sub-distribution hazard ration (SHR) = 1.02,
95% CI: 1.01 - 1.02. This means that weight gain in a month increased chances
of curing MDR-TB by 2%. Results show that lower chances to cure MDR-TB were among patients between 41 to 50 years compared to
those patients who were between 18 to 30 years old (SHR = 0.80, 95% CI: 0.61 -
1.06). The chances of curing MDR-TB in female patients were low compared to male patients (SHR = 0.84, 95% CI =
0.68 - 1.03), however this was not significant. Furthermore, HIV negative
patients had higher chances to cure MDR-TB (SHR = 1.07, 95% CI: 0.85 - 1.35)
compared to HIV positive patients. Patients who were treated in the
decentralised sites had lower chances to be cured of MDR-TB (SHR = 0.19, 95%
CI: 0.07 - 0.54) as compared to patients who were treated in the centralised
hospital. Conclusion: Identifying key factors
associated with TB and specifying strategies to prevent them can reduce
mortality of patients due to TB disease, hence positive treatment outcomes
leading to the goal of reducing or end TB deaths. Urgent action is required to
improve the coverage and quality of diagnosis, treatment and care for people
with drug-resistant TB.