TREATMENT OUTCOMES IN DRUG-SENSITIVE TUBERCULOSIS PATIENTS WITH AND WITHOUT NON-COMMUNICABLE CO-MORBIDITIES AT A TERTIARY HEALTH CARE FACILITY IN NORTHERN INDIA: A PROSPECTIVE COHORT STUDY
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Keywords
Co-morbidity impact, Drug-sensitive TB, non-communicable co-morbidities (NCCs), Tuberculosis (TB), Treatment outcomes
Abstract
Background: Tuberculosis is a leading global health issue, with a high burden in developing countries. Non-communicable co-morbidities (NCCs) such as diabetes, hypertension, and chronic respiratory diseases are increasingly recognized as factors that complicate TB treatment. This study investigates the impact of NCCs on treatment outcomes in drug-sensitive TB patients.
Methods: This prospective cohort study was conducted at UPUMS Saifai Etawah between January 2023 and July 2024. A total of 144 drug-sensitive TB patients were divided into two groups: group 1 (TB patients with co-morbidities) and group 2 (TB patients without co-morbidities). The primary outcomes assessed were cure rate, treatment completion, treatment failure, mortality, and loss to follow-up. Statistical analyses, including Chi-square tests and relative risk (RR) calculations, were performed to evaluate the impact of co-morbidities.
Results: Group 1 had a significantly worse treatment outcome compared to group 2. The cure rate was lower in group 1 (23.61% vs. 38.89%), while mortality was higher (22.22% vs. 8.33%). Treatment failure occurred in 5.56% of group 1 but was absent in group 2. Smoking/tobacco use (73.61%) and malnutrition (44.44%) were the most common co-morbidities in group 1, both contributing to poorer treatment outcomes. Group 1 also had a higher mean age, a predominance of males, and lower literacy rates, all of which contributed to the disparity in outcomes.
Conclusions: The presence of NCCs significantly worsens treatment outcomes in TB patients, leading to lower cure rates and higher mortality. Diabetes and hypertension were the most impactful co-morbidities. Integrated care approaches that address both TB and NCCs are essential to improve treatment success and reduce mortality in TB patients with co-morbidities.
References
2. Kochi A. Tuberculosis control - Is DOTS the health breakthrough of the 1990s? World Health Forum 2001; 18:225.
3. Moulding TS. Medication monitors to treat tuberculosis, A supplement to directly observed therapy. Am J Respir Crit Cure Mecl 2001; 159:989.
4. Falab-Stubi CL, Zellweger JP, Sauty A, Uldry C, lorillo D, Burner M. Electronic monitoring of adherence to treatment in the preventive chemotherapy of tuberculosis. Int J Tuberc. Lung Disease1998; 2:525.
5. TB India 2017. RNTCP annual status report (2017). Accessed: September 3, 2020: https://tbcindia.gov.in/WriteReadData/TB%20India%202017.pdf
6. Ahmed M, Omer I, Osman SMA, Ahmed‐Abakur EH. Association between pulmonary tuberculosis and type 2 diabetes in Sudanese patients. Int J Mycobacteriol 2017; 6:5
7. Lönnroth K, Williams BG, Stadlin S, Jaramillo E, Dye C. Alcohol use as a risk factor for tuberculosis - a systematic review. BMC Public Health 2008; 8:2:289.
8. Forouzanfar MH, Afshin A, Alexander LT, H. Ross; Bhutta, Zulficiar A.; Biryukov, Stan; Brauer, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990−2015: a systematic analysis for the global burden of disease study 2015. Lancet 2016; 388:1659–17246.
9. Creswell J, Raviglione M, Ottmani S, Migliori G.B., Uplekar M., Blanc L., Sotgiu G. et al. Tuberculosis and non-communicable diseases: neglected links and missed opportunities. Eur Respir J 2011; 37:1269–1282.
10. Segafredo G, Kapur A, Robbiati C, Nsuka Joseph, Joseth Rita dsousa, G putoto et al. Integrating TB and non-communicable diseases services: pilot experience of screening for diabetes and hypertension in patients with Tuberculosis in Luanda, Angola. PLoS ONE 2019;14: e0218052.
11. Lin YH, Chen CP, Chen PY, Huang JC, Ho C, Weng HH, et al. Screening for pulmonary tuberculosis in type 2 diabetes elderly: a cross-sectional study in a community hospital. BMC Public Health 2015; 15:3.
12. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis 2009; 9:737–746.
13. Marais BJ, Lönnroth K, Lawn SD, Migliori GB, Mwaba P, Glaziou P, et al. Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts. Lancet Infect Dis 2013; 13:436–448.
14. American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes Care. 2018 Jan 1;41(Supplement_1): S13-S27.
15. World Health Organization. WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. World Health Organization; 2011. Accessed 20 Jan 2023. Health.
16. World Health Organization. (2004). Global Strategy on Diet, Physical Activity and Retrieved from WHO Diet and Physical Activity Strategy.Accessed 20 Jan 2023.
17. Ewing JA. Detecting alcoholism: the CAGE questionnaire. Jama. 1984 Oct 12;252(14):1905-1907.
18. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020 Jun;75(6):1334-1357.
19. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the prevention, diagnosis, and management of COPD 2024 report. 2024. Available from: https://goldcopd.org/gold-reports/
20. National Tuberculosis Elimination Program. (2020). Guidelines for Programmatic Management of Tuberculosis. Ministry of Health and Family Welfare, Government of India. Available at: https://tbcindia.gov.in/index1.php?lang=1&level=2&sublinkid=431&lid=30
21. Balakrishnan S, Vijayan S, Nair S, Subramoniapillai J, Mrithyunjayan S, Wilson N, et al. High diabetes prevalence among tuberculosis cases in Kerala, India. PloS one. 2012;7(10): e46502
22. Shivalingaiah AH, RamegowdaC, Masthi NRR. A study on co-morbidities and treatment outcome based on updated definitions among tuberculosis patients registered at a tuberculosis unit, Bangalore. Int J Community Med Public Health 2017; 4:1071-4.
23. Adane HT, Howe RC, Wassie L, Magee MJ. Diabetes mellitus is associated with an increased risk of unsuccessful treatment outcomes among drug susceptible tuberculosis patients in Ethiopia: A prospective health facility-based study. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2023 May 1; 31:100368.
24. Nowiński A, Wesołowski S, Korzeniewska-Koseła M. The impact of comorbidities on tuberculosis treatment outcomes in Poland: a national cohort study. Frontiers in Public Health. 2023 Sep 5;11: 1253615.
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Dr. Adesh Kumar
Professor and Head, Department of Respiratory Medicine, UP University of Medical Sciences, Saifai, Etawah, UP.
Dr. Prashant Yadav
Associate Professor, Department of Respiratory Medicine, UP University of Medical Sciences, Saifai, Etawah, UP.
Dr. Ashish Kumar Gupta
Professor, Department of Respiratory Medicine, UP University of Medical Sciences, Saifai, Etawah, UP.
Dr. Aditya Kumar Gautam
Professor, Department of Respiratory Medicine, UP University of Medical Sciences, Saifai, Etawah, UP.
Dr. Asad Ahmad
Junior resident, Department of Respiratory Medicine UP University of Medical Sciences, Saifai, Etawah, UP, Mobile – 7905111623
Dr. Naresh Pal Singh
Professor, Department of Community Medicine, UP University of Medical Sciences, Saifai, Etawah, UP