NRU :: Browsing by Author "Izudi, Jonathan"

Browsing by Author "Izudi, Jonathan"

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Alcohol consumption and sports-betting among young male motorcycle taxi boda boda riders in urban southwestern Uganda.
(BMC public health, 2021) Nabifo, Stella Cheryl; Izudi, Jonathan; Bajunirwe, Francis
The popularity of sports-betting is growing globally and may be associated with alcohol consumption among young adults. In this study, we examine the relationship between alcohol consumption plus other substances with sports-betting in a group of young adult males in Uganda. We conducted a cross-sectional study and interviewed male motorcycle taxi boda boda riders in the southwestern Uganda town of Mbarara. We asked questions about alcohol consumption, smoking plus history and frequency of sports-betting. We enrolled 401 riders. The median age was 29.0 years, interquartile range 25–32 years. Seventy four (18.5%) had engaged in sports-betting in the past 30 days. Among those that reported sports-betting, 16(21.6%) engaged daily or almost daily. Alcohol use was significantly associated with sports-betting with an adjusted risk ratio (aRR) of 2.08(95% CI 1.36, 3.18) among moderate drinkers but not among heavy drinkers in comparison to low or non-drinkers. Cigarette smoking was significantly associated with sports-betting with an aRR 1.85(95% CI 1.13, 3.01). Sports-betting is common among these young male motorcycle riders, and is associated with both alcohol consumption and cigarette smoking. Interventions to regulate sports-betting may be co-packaged with those to reduce alcohol consumption and cigarette smoking among young adult males.
Association between GeneXpert Diagnosis and Same-Day Initiation of Tuberculosis Treatment in Rural Eastern Uganda.
(The American Journal of Tropical Medicine and Hygiene, 2020) Izudi, Jonathan; Tamwesigire, Imelda K.; Bajunirwe, Francis
Diagnosis of tuberculosis with GeneXpert and same-day initiation of tuberculosis treatment (SITT) has important public health and clinical benefits. GeneXpert allows for rapid diagnosis, hence presenting an opportunity for SITT. We determined the association between GeneXpert diagnosis and SITT, and the effect of SITT on treatment success rate among adult persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) in rural eastern Uganda. We conducted a retrospective cohort study using routinely collected data at 10 health facilities, used modified Poisson regression analysis to determine the association between GeneXpert and SITT, and expressed the results as risk ratio (RR). We used propensity score-matched analysis to match SITT participants to delayed initiation of treatment (DIT) participants and then performed logistic regression analysis to determine the independent effect of SITT on treatment success rate, expressed as odds ratio (OR). Of 1,045 participants, 764 (73.1%) had SITT. The use of GeneXpert for diagnosis of tuberculosis was associated with higher likelihood of SITT (adjusted RR [aRR], 1.28; 95% CI: 1.19–1.37) and for persons with new BC-PTB diagnosis (aRR, 1.16; 95% CI: 1.02–1.32). We successfully matched 530 participants (265 in SITT and 265 in DIT) through 1:1 nearest neighbor caliper matching. Before propensity score-matched analysis, SITT was not significantly associated with treatment success rate (adjusted OR, 0.97; 95% CI: 0.70–1.33). After propensity scorematched analysis, SITT remained nonsignificantly associated with treatment success rate (OR, 0.96; 95% CI: 0.67–1.40). GeneXpert thus increases the likelihood of SITT, but SITT has no significant effect on treatment success rate.
Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis
(PloS one, 2019) Izudi, Jonathan; Tamwesigire, Imelda K.; Bajunirwe, Francis
Tuberculosis is a global public health problem. Bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients require three sputum smear monitoring (SSM) tests to establish cure or treatment success, but few studies have assessed the relationship. We evaluated the effect of completing SSM on treatment success rate (TSR) among adult BC-PTB patients in rural eastern Uganda.We conducted a propensity score-matched (PSM) analysis of a retrospective observational cohort data. Participants who completed SSM were matched to those who had not, through nearest neighbor 1:1 caliper matching. Balance of baseline characteristics between the groups was compared before and after PSM using standardized mean differences. Logistic regression analysis was performed in matched and unmatched samples, reported as odds ratio (OR) with 95% confidence intervals (CI). Robustness of the results to hidden bias was checked through sensitivity analysis. The primary outcome was TSR (treatment completion or cure), while the secondary was cure rate, measured as an individual outcome.Before PSM, 591 (72.3%) of the 817 participants had incomplete SSM, with statistically significant differences in baseline covariates between completers and non-completers. After PSM, there were 185 participants in either group, balanced on baseline covariates. Before PSM, SSM completion was not associated with TSR, with unadjusted (OR, 0.92; 95%CI, 0.32–2.63) and adjusted analysis (Adjusted OR, 1.32; 95%CI, 0.41–4.22). For cure rate, there was a statistically significant effect before (OR, 93.34; 95%CI, 29.53–295.99) and after adjusted analysis (Adjusted OR, 86.24; 95%CI, 27.05–274.94), although imprecise. In PSM analysis, SSM completion was associated with increased odds of cure (OR, 87.00; 95%CI, 12.12–624.59) but not TSR (OR, 1.67; 95%CI, 0.40–6.97).Completing SSM increases cure but has no effect on TSR among adult BC-PTB patients in eastern Uganda. Implementation of SSM should be encouraged to ensure improvement in cure rates among tuberculosis patients in rural areas.
Effect of disclosure of HIV Status on Patient rRepresentation and Adherence to Clinic visits in Eastern Uganda: A Propensity-score Matched Analysis
(Plos one,, 2021) Izudi, Jonathan; Okoboi, Stephen; Lwevola, Paul; Kadengye, Damazo; Bajunirwe, Francis
Disclosure of human immunodeficiency virus (HIV) status improves adherence to antiretroviral therapy (ART) and increases the chance of virological suppression and retention in care. However, information on the effect of disclosure of HIV status on adherence to clinic visits and patient representation is limited. We evaluated the effects of disclosure of HIV status on adherence to clinic visits and patient representation among people living with HIV in eastern Uganda.In this quasi-randomized study, we performed a propensity-score-matched analysis on observational data collected between October 2018 and September 2019 from a large ART clinic in eastern Uganda. We matched participants with disclosed HIV status to those with undisclosed HIV status based on similar propensity scores in a 1:1 ratio using the nearest neighbor caliper matching technique. The primary outcomes were patient representation (the tendency for patients to have other people pick-up their medications) and adherence to clinic visits. We fitted a logistic regression to estimate the effects of disclosure of HIV status, reported using the odds ratio (OR) and 95% confidence interval (CI).Of 957 participants, 500 were matched. In propensity-score matched analysis, disclosure of HIV status significantly impacts adherence to clinic visits (OR = 1.63; 95% CI, 1.13–2.36) and reduced patient representation (OR = O.49; 95% CI, 0.32–0.76). Sensitivity analysis showed robustness to unmeasured confounders (Gamma value = 2.2, p = 0.04).Disclosure of HIV status is associated with increased adherence to clinic visits and lower representation to collect medicines at the clinic. Disclosure of HIV status should be encouraged to enhance continuity of care among people living with HIV.
Effect of the COVID-19 Pandemic Restrictions on Outcomes of HIV Care among Adults in Uganda
(Medicine, 2022) Izudi, Jonathan; Kiragga, Agnes; Kalyesubula, Philip; Okoboi, Stephen; Castelnuovo, Barbara
Uganda enforced several stringent restrictions such as night-time curfews, travel bans, school closure, and physical and social distancing among others that constituted a national lockdown to prevent the spread of the Coronavirus disease 2019 (COVID-19). These restrictions disrupted the delivery of health services but the impact on outcomes of human immunodeficiency virus (HIV) care has not been rigorously studied. We evaluated the effect of the COVID-19 pandemic restrictions on outcomes of HIV care among people living with HIV (PLHIV) aged ≥15 years in Kampala, Uganda. We designed a nonrandomized, quasi-experimental study using observational data retrieved from six large HIV clinics and used the data to construct two cohorts: a comparison cohort nonexposed to the restrictions and an exposed cohort that experienced the restrictions. The comparison cohort consisted of PLHIV commenced on anti-retroviral therapy (ART) between March 1, 2018, and February 28, 2019, followed for ≥1 year with outcomes assessed in March 2020, just before the restrictions were imposed. The exposed cohort comprised of PLHIV started on ART between March 1, 2019, and February 28, 2020, followed for ≥1 year with outcomes assessed in June 2021. The primary outcomes are retention, viral load testing, viral load suppression, and mortality. We employed inverse probability of treatment weighting using propensity score (IPTW-PS) to achieve comparability between the two cohorts on selected covariates. We estimated the effect of the restriction on the outcomes using logistic regression analysis weighted by propensity scores (PS), reported as odds ratio (OR) and 95% confidence interval (CI). We analyzed data for nine, 952 participants, with 5094 (51.2%) in the exposed group. The overall mean age was 32.7 ± 8.8 years. In the exposed group relative to the comparison group, viral load testing (OR, 1.68; 95% CI, 1.59–1.78) and viral load suppression (OR, 1.34; 95% CI, 1.110–1.63) increased while retention (OR, 0.76; 95% CI, 0.70–0.81) and mortality (OR, 0.75; 95% CI, 0.64–0.88) reduced. Among PLHIV in Kampala, Uganda, viral load testing and suppression improved while retention and mortality reduced during the COVID-19 pandemic restrictions due to new approaches to ART delivery and the scale-up of existing ART delivery models.
Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural eastern Uganda
(BMC health services research, 2019) Izudi, Jonathan; Tamwesigire, Imelda. K.; Bajunirwe, Francis
Optimally performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors associated with the low and high TSR across four districts in rural eastern Uganda.We interviewed District TB and Leprosy Supervisors, Laboratory focal persons, and health facility TB focalpersons from four districts in eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes. The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and prioritization of better management of people with TB. The barriers common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities, and a poor implementation of community-based directly observed therapy short course.This study shows that several factors are associated with the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.
High Baseline CD4 Count and Exclusive Breastfeeding Are Associated with Lower Rates of Mother to Child HIV Transmission in Northwestern Uganda: A Two-Year Retrospective Cohort Study
(Advances in Public Health, 2018) Izudi, Jonathan; Apangu, Pontius; Bajunirwe, Francis; Mulogo, Edgar; Batwala, Vincent
Under Option B plus, the transmission of Human Immunodeficiency Virus (HIV) along the Early Infant Diagnosis (EID) of HIV cascade remains unknown. We described HIV transmission along the EID cascade and determined associated factors at Arua Regional Referral Hospital, Northwestern Uganda. Methods. Data on 295 mother-baby pairs in EID care (January 2014 and April 2015) was extracted, cleaned, and analysed in STATA. Univariate, bivariate, and multivariate analyses were performed. Independently associated factors were stated in adjusted odds ratio (AOR), 95% confidence interval (CI), and -values. Results. 233 (89.0%) mothers were above 30 years, 251 (85.1%) were in World Health Organization (WHO) clinical stages I/II at enrolment, 170 (57.6%) attended antenatal care (ANC) visits during recent pregnancy, and 204 (69.1%) delivered in a health facility. Meanwhile, 257 (87.1%) HIV Exposed Infants (HEIs) received Nevirapine prophylaxis from birth up to 6 weeks and 245 (83.0%) were exclusively breastfed during the first 6 months. Of 295 mother-baby pairs, 25 (8.5%) HEIs turned HIV-positive along the EID cascade. Baseline maternal CD4 count of more than 500 cells/ul compared to less than 500 cells/ul (adjusted odds ratio (AOR) = 0.29; 95% Confidence Interval (CI): 0.10–0.85; = 0.024) and exclusive breastfeeding (EBF) in the first 6 months of delivery in contrast to not EBF in the first 6 months (AOR = 0.17; 95% CI: 0.52–0.55; = 0.003) reduced HIV transmission. Meanwhile, ANC visits, place of delivery, time of Nevirapine initiation, and maternal antiretroviral therapy use were not significantly associated with infant HIV transmission. Conclusion. HIV transmission was high. High baseline CD4 count and exclusive breastfeeding reduced HIV transmission.
HIV infection modifies the relationship between distance to a health facility and treatment success rate for tuberculosis in rural eastern Uganda
(Journal of clinical tuberculosis and other mycobacterial diseases, 2021) Olupota, Ben; Adrawa, Norbert; Bajunirwe, Francis; Izudi, Jonathan
Distance from residence to a health facility especially in rural areas presents a physical barrier and may influence tuberculosis (TB) treatment outcomes.We examined the association between distance from residence to a health facility and TB treatment outcomes namely treatment success rate (TSR) and mortality, and whether HIV influences this relationship among people with TB in Kumi district in rural eastern Uganda.In this cross-sectional design, we abstracted data from TB unit registers across four large health facilities. Travel of ≥5 km to a health facility was considered a long distance. The primary outcome was TSR and the secondary was mortality. We performed a generalized linear model with Poisson distribution with a log-link and robust standard errors to determine the association between distance and the study outcomes adjusting for potential confounders. We report the adjusted risk ratio (aRR) and 95% confidence interval (CI).Of 611 participants studied, 484 (79.2%) were successfully treated, 18 (2.9%) died, and 359 (58.7%) travelled a long distance to access TB treatment. Long-distance was significantly associated with lower TSR (aRR, 0.93; 95% CI, 0.89–0.96). Further analysis showed that longer distance was associated with lower TSR among HIV positive persons with TB (aRR, 0.83; 95% CI, 0.72–0.96), but not among HIV negative persons with TB (aRR, 0.94; 95% CI, 0.85–1.03). Although it was not significant, longer distance showed a tendency towards worse mortality among HIV positive people with TB (aRR, 2.78; 95% CI, 0.80–9.66), but not among HIV negative people with HIV (aRR, 0.21; 0.03–1.74).A majority of people with TB travel long distances to access treatment. Long distances are associated with lower TSR and higher mortality and affect people with TB who are HIV positive but not HIV negative. Interventions should focus on improving access to treatment for people with TB who travel long distances.
Long-distance truck drivers and the increasing risk of COVID-19 spread in Uganda
(International Journal of Infectious Diseases, 2020) Bajunirwe, Francis; Izudi, Jonathan; Asiimwe, Stephen;
To examine the patterns of COVID-19 transmission in Uganda.We reviewed ten weeks of press releases from the Uganda Ministry of Health from the day when the first case was announced, March 22, through May 29, 2020. We obtained the press releases from the MoH website and the Twitter handle (@MinofHealthUG). Data include the number of persons tested and the categories were classified as international arrivals, community members, and long-distance truck drivers.The first cases were international arrivals from Asia and Europe, and after that, community cases emerged. However, in the middle of April 2020, COVID-19 cases were detected among long-distance truck drivers. By May 29, 2020, 89, 224 persons had been tested; overall, 442 tested positive. Of those that tested positive, the majority, or 317 (71.8%) were truck drivers, 75 (16.9%) were community cases, and 50 (11.3%) were international arrivals. The majority of community cases have been linked to contact with truck drivers.Truck drivers were the most frequently diagnosed category, and have become a core group for COVID-19 in Uganda. They have generated significant local transmission, which now threatens a full-blown epidemic unless strict controls are put in place.
Negative effects of undernutrition on sputum smear conversion and treatment success among retreatment cases in Uganda: A quasi-experimental study
(Elsevier Ltd, 2024-05) Izudi, Jonathan; Bajunirwe, Francis; Cattamanchi, Adithya
The causal relationship between undernutrition and response to anti-tuberculosis (TB) treatment and TB treatment outcomes among people with retreatment TB is understudied. To evaluate the effect of undernutrition on treatment success and sputum smear conversion among people with retreatment drug-susceptible TB in Kampala, Uganda. We conducted a quasi-experimental study utilizing propensity score weighting among people with retreatment drug-susceptible TB aged ≥ 15 years treated between 2012 and 2022 in Kampala. The primary exposure was undernutrition assessed using the mid-upper arm circumference at the time of TB diagnosis. The primary outcome was treatment success defined as cure or treatment completion at month 6. Sputum smear conversion was the secondary outcome and was measured as a change in sputum smear status from positive to negative at months 2, 5, and 6. We estimated the causal effect of undernutrition on the outcomes using a propensity-score weighted modified Poisson regression model with robust error variance. Of the 605 participants, 432 (71.4 %) were male, 215 (35.5 %) were aged 25-34 years, 427 (70.6 %) had bacteriologically confirmed pulmonary TB, 133 (22.0 %) were undernourished and 398 (65.8 %) achieved treatment success. Of participants with bacteriologically confirmed pulmonary TB, 232 (59.0 %), 327 (59.3 %), and 360 (97.6 %) achieved sputum smear conversion at months 2, 5, and 6, respectively. Undernutrition reduced treatment success (RR 0.42, 95 % CI 0.32-0.55) as well as sputum smear conversion at months 2 (RR 0.45, 95 % CI 0.42-0.49) and 5 (RR 0.46, 95 % CI 0.43-0.51) but not month 6 (RR 0.99, 95 % CI 0.97-1.02). Undernutrition negatively impacts treatment outcomes. Therefore, nutritional assessment should be an integral component of TB care, with nutritional counseling and support offered to those undernourished to optimize their TB treatment response and outcomes.
Protocol for systematic review and meta-analysis of treatment success rate among adult patients with tuberculosis in sub-Saharan Africa
(BMJ open, 2018) Izudi, Jonathan; Semakula, Daniel; Sennono, Richard; Tamwesigire, Imelda K.; Bajunirwe, Francis
Tuberculosis (TB) is a leading cause of mortality globally. Despite being curable, treatment success rates (TSRs) among adult patients with bacteriologically confirmed pulmonary TB (BC-PTB) in sub-Saharan Africa (SSA) differ considerably. This protocol documents and presents an explicit plan of a systematic review and meta-analysis to summarise TSR among adult patients with BC-PTB in SSA.Two reviewers will search and extract data from MEDLINE, EMBASE, Ovid, Cumulative Index to Nursing and Allied Health Literature and Web of Science electronic databases. Observational and interventional studies published between 1 July 2008 and 30 June 2018, involving adult patients with BC-PTB will be eligible. Data abstraction disagreements will be resolved by consensus with a third reviewer, while percentage agreement computed with kappa statistics. TSR will be computed with Metaprop, a Stata command for pooling proportions using DerSimonian and Laird random effects model and presented in a forest plot with corresponding 95% CIs. Heterogeneity between included studies will be assessed with Cochran’s Q test and quantified with I-squared values. Publication bias will be evaluated with funnel plots and tested with Egger’s weighted regression. Time trends in TSR will be calculated with cumulative meta-analysis.
Retention of HIV exposed infants in care at Arua regional referral hospital, Uganda: a retrospective cohort study
(BMC public health,, 2019) Apangu, Pontius; Izudi, Jonathan; Bajunirwe, Francis; Mulogo, Edgar; Batwala, Vincent
Retention of HIV Exposed Infants (HEIs) in care ensures adequate care. Data on retention of HEIs at large referral hospitals in Uganda is limited. We investigated the retention level of HEIs and associated factors. We conducted a retrospective cohort study on 352 HEIs in care (January 2014 and April 2015) at Arua Regional Referral Hospital, North-western Uganda. Electronic medical data were retrieved and analyzed with Stata. Chi-square, Fisher’s exact, and Students t-tests were used for bivariate analysis. Logistic regression was performed to determine factors independently associated with retention. 236 (67.0%) HEIs were delivered in a health facility and 306 (86.9%) received Nevirapine prophylaxis from birth until 6-weeks. Of mothers, 270 (76.7%) were 25–46 years, 202 (57.4%) attended antenatal care (ANC) at recent pregnancy, and 328 (93.2%) were on life-long anti-retroviral therapy. At 18-months, 277 (78.7%) HEIs were retained in care. Maternal age (25–46 years) (Adjusted Odds Ratio (AOR), 2.32; 95% CI, 1.32–4.06), ANC attendance during recent pregnancy (AOR, 2.01; 95% CI, 1.19–4.3.41) and Nevirapine prophylaxis initiation from birth until 6-weeks (AOR, 3.07; 95% CI, 1.50–6.26) were associated with retention. Retention was suboptimal. Older maternal age, ANC visits at last pregnancy, and timely NVP initiation increased retention
Retention of HIV exposed infants in care at Arua regional referral hospital, Uganda: a retrospective cohort study
(BMC public health, 2019) Apangu, Pontius; Izudi, Jonathan; Bajunirwe, Francis; Mulogo, Edgar; Batwala, Vincent
Retention of HIV Exposed Infants (HEIs) in care ensures adequate care. Data on retention of HEIs at large referral hospitals in Uganda is limited. We investigated the retention level of HEIs and associated factors.We conducted a retrospective cohort study on 352 HEIs in care (January 2014 and April 2015) at Arua Regional Referral Hospital, North-western Uganda. Electronic medical data were retrieved and analyzed with Stata. Chi-square, Fisher’s exact, and Students t-tests were used for bivariate analysis. Logistic regression was performed to determine factors independently associated with retention.236 (67.0%) HEIs were delivered in a health facility and 306 (86.9%) received Nevirapine prophylaxis from birth until 6-weeks. Of mothers, 270 (76.7%) were 25–46 years, 202 (57.4%) attended antenatal care (ANC) at recent pregnancy, and 328 (93.2%) were on life-long anti-retroviral therapy. At 18-months, 277 (78.7%) HEIs were retained in care. Maternal age (25–46 years) (Adjusted Odds Ratio (AOR), 2.32; 95% CI, 1.32–4.06), ANC attendance during recent pregnancy (AOR, 2.01; 95% CI, 1.19–4.3.41) and Nevirapine prophylaxis initiation from birth until 6-weeks (AOR, 3.07; 95% CI, 1.50–6.26) were associated with retention.Retention was suboptimal. Older maternal age, ANC visits at last pregnancy, and timely NVP initiation increased retention.
Sputum Smear Non-Conversion Among Adult Persons With Bacteriologically Confirmed Pulmonary Tuberculosis In Rural Eastern Uganda
(Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 2020) Izudi, Jonathan; Tamwesigire, Imelda K.; Bajunirwe, Francis
Failure to convert sputum at two months of treatment among persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) indicates poor response to treatment but data are limited on its assessment.We determined the frequency and factors associated with sputum smear non-conversion at two months among persons with BC-PTB in eastern Uganda.We abstracted data of adult persons with BC-PTB, from routinely available records from TB registers at 10 clinics in eastern Uganda. We determined factors that are independently associated with sputum smear non-conversion using logistic regression analysis. We expressed the results as odds ratio (OR) with 95% confidence interval (CI).Of 516 persons with BC-PTB, 81 (15.7%) did not achieve sputum smear conversion at two months of TB treatment. Higher Mycobacteria tuberculosis (MTB) load and treatment at a private-not-for-profit (PNFP) facility compared to government health facility were significantly associated with sputum smear non-conversion. A one unit (+1) increase in MTB load based on ZN stain counts was associated with a 48% increase in the odds of sputum smear non-conversion with adjusted odds ratio (AOR), 1.48 (95% CI, 1.02–2.18). TB treatment at private-not-for-profit health facility was associated with a two-fold increase in the odds of sputum smear non-conversion (AOR, 2.03; 95% CI, 1.01–3.92).Our study shows that sputum smear non-conversion is common at two months of treatment in this population. It is more likely among patients with higher baseline MTB load and those treated at PNFP facilities. Strategies targeting patients with these risk factors are needed to enhance sputum smear conversion.
Surveillance For Multi-Drug And Rifampicin Resistant Tuberculosis And Treatment Outcomes Among Previously Treated Persons With Tuberculosis In The Era Of Genexpert In Rural Eastern Uganda
(Journal of clinical tuberculosis and other mycobacterial diseases, 2020) Izudi, Jonathan; Tamwesigire, Imelda K.; Bajunirwe, Francis
Previously treated persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) have increased risk of developing multi-drug resistant or rifampicin resistant tuberculosis (MDR/RR-TB). Surveillance for resistance is critical to identify and treat MDR/RR-TB to ensure cure and prevent transmission. There are limited studies conducted on this subject.We examined the frequency and factors associated with MDR/RR-TB surveillance among previously treated persons with BC-PTB, and described their treatment outcomes in rural eastern Uganda.We reviewed treatment records for BC-PTB between January 2015 and June 2018 at 10 clinics in eastern Uganda. We collected data on demographics, surveillance for MDR/RR, use of GeneXpert and treatment outcomes. We performed bivariate and multivariate analyses. For multivariate analysis, we used the modified Poisson regression analysis with robust standard errors and stated the results as adjusted risk ratio (aRR) with 95% confidence intervals (CI). All analyses were conducted in R version 3.5.2.We obtained records for 135 previously treated persons with BC-PTB and of these, 41 (30.4%) had undergone surveillance for MDR/RR-TB. Treatment failures were less likely to have surveillance compared to relapses (aRR, 0.28; 95% CI, 0.08–0.95), and there was an increasing trend in the likelihood for surveillance between 2015 and 2018 (aRR, 1.77; 95% CI, 1.39–2.25). There was no difference in MDR/RR-TB surveillance rate between health facilities with and without GeneXpert on-site (aRR, 1.52; 95% CI, 0.81–2.86) and between male and female patients (aRR, 0.54; 95% CI, 0.21–1.37). Overall, 92 (68.1%) previously treated persons with BC-PTB were successfully treated for tuberculosis.MDR/RR-TB surveillance and treatment success rates among previously treated persons with BC-PTB in rural eastern Uganda are low. Tuberculosis programs should strengthen MDR/RR-TB surveillance and especially target those with treatment failure.
Treatment Success And Mortality Among Adults With Tuberculosis In Rural Eastern Uganda: A Retrospective Cohort Study
(BMC public health, 2020) Izudi, Jonathan; Tamwesigire, Imelda K.; Bajunirwe, Francis
Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high dual tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda.We constructed a retrospective cohort of persons with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we ran a modified Poisson regression analysis to determine factors independently associated with treatment success and mortality rates.We retrieved 1123 records for persons with BC-PTB and the treatment outcomes were distributed as follows: 477(42.5%) cured, 323 (28.0%) treatment completed, 17(1.5%) treatment failed, 81(7.2%) died, 89(7.9%) lost to follow-up, and 136(12.1%) not evaluated. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had treatment outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82–0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81–0.97), or male sex (aRR, 0.92; 95% CI, 0.87–0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95–6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74–4.92), year of enrollment into treatment after 2015 (aRR, 0.80; 95% CI, 0.66–0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13–0.50).Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality rate is high. HIV infection and older age reduce chances of treatment success, and increase mortality rate. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success rate and reduce mortality rate.
Treatment success rate among adult pulmonary tuberculosis patients in sub- Saharan Africa: a systematic review and meta-analysis
(BMJ open, 2019) Izudi, Jonathan; Semakula, Daniel; Sennono, Richard; Tamwesigire, Imelda K; Bajunirwe, Francis
summarise treatment success rate (TSR) among adult bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients in sub-Saharan Africa (SSA).We searched MEDLINE, EMBASE, Google Scholar and Web of Science electronic databases for eligible studies published in the decade between 1 July 2008 and 30 June 2018. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. We used random-effects model to pool TSR in Stata V.15, and presented results in a forest plot with 95% CIs and predictive intervals. We assessed heterogeneity with Cochrane’s (Q) test and quantified with I-squared values. We checked publication bias with funnel plots and Egger’s test. We performed subgroup, meta-regression, sensitivity and cumulative meta-analyses. Adults 15 years and older, new and retreatment BC-PTB patients.TSR measured as the proportion of smear-positive TB cases registered under directly observed therapy in a given year that successfully completed treatment, either with bacteriologic evidence of success (cured) or without (treatment completed).31 studies (2 cross-sectional, 1 case–control, 17 retrospective cohort, 6 prospective cohort and 5 randomised controlled trials) involving 18 194 participants were meta-analysed. 28 of the studies had good quality data. Egger’s test indicated no publication bias, rather small study effect. The pooled TSR was 76.2% (95% CI 72.5% to 79.8%; 95% prediction interval, 50.0% to 90.0%, I2 statistics=96.9%). No single study influenced the meta-analytical results or conclusions. Between 2008 and 2018, a gradual but steady decline in TSR occurred in SSA but without statistically significant time trend variation (p=0.444). The optimum TSR of 90% was not achieved.Over the past decade, TSR was heterogeneous and suboptimal in SSA, suggesting context and country-specific strategies are needed to end the TB epidemic.
Treatment Supporters And Level Of Health Facility Influence Completion Of Sputum Smear Monitoring Among Tuberculosis Patients In Rural Uganda: A Mixed-Methods Study
(International Journal of Infectious Diseases, 2020) Izudi, Jonathan; Tamwesigire, Imelda K.; Bajunirwe, Francis
To investigate whether treatment supporters influence the completion of sputum smear monitoring (SSM) among adult persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB), and to explore the reasons for incomplete SSM according to healthcare workers, persons with BC-PTB, and their treatment supporters in rural eastern Uganda.A mixed-methods design was used. Quantitative data were abstracted from tuberculosis unit registers, while qualitative data were obtained through key informant interviews with healthcare workers and in-depth interviews with persons with BC-PTB and their treatment supporters. Quantitative data were analyzed with Stata. Qualitative data were transcribed verbatim and analyzed using a thematic content approach.Records were abstracted for 817 patients. Of these, 226 (27.7%) completed SSM. Factors independently associated with SSM completion included having a treatment supporter (adjusted risk ratio (ARR) 2.40, 95% confidence interval (CI) 1.23–4.70), treatment at a district hospital (ARR 1.61, 95% CI 1.04–2.49), treatment at a regional referral hospital (ARR 2.00, 95% CI 1.46–2.73), and every additional year since 2015 (ARR 1.29, 95% CI 1.17–1.43). Reasons for incomplete SSM related to health system, patient, treatment supporter, and healthcare provider factors.Completion of SSM was low. Persons with BC-PTB who have a treatment supporter were more likely to complete SSM compared to those without, and those receiving treatment at higher level facilities were more likely to complete SSM compared to those at lower level ones.

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