Risk factors for tuberculosis smear non-conversion in Eden district, Western Cape, South Africa, 2007-2013 : a retrospective cohort study
dc.contributor.author | Mlotshwa, Mandla | |
dc.contributor.author | Abraham, Natasha | |
dc.contributor.author | Beery, Moira | |
dc.contributor.author | Williams, Seymour | |
dc.contributor.author | Smit, Sandra | |
dc.contributor.author | Uys, Margot | |
dc.contributor.author | Reddy, Carl | |
dc.contributor.author | Medina-Marino, Andrew | |
dc.date.accessioned | 2016-09-12T05:11:59Z | |
dc.date.available | 2016-09-12T05:11:59Z | |
dc.date.issued | 2016-08 | |
dc.description.abstract | BACKGROUND : Tuberculosis (TB) continues to be a major global health problem. While progress has been made to improve TB cure rates, South Africa’s 76 % smear-positive pulmonary TB (PTB) case cure rate remains below the WHO target of 85 %. We report on the trends of TB smear non-conversion and their predictors at the end of an intensive phase of treatment, and how this impacted on treatment outcomes of smear-positive PTB cases in Eden District, Western Cape Province, South Africa. METHODS : Routinely collected, retrospective data of smear-positive PTB cases from the electronic TB register in Eden District between 2007 and 2013 was extracted. Non-conversion was defined as persistent sputum smear-positive PTB cases at the end of the two or three month intensive phase of treatment. Chi-square test for linear trend and simple linear regression analysis were used to analyse the change in percentages and slope of TB smear non-conversion rates over time. Risk factors for TB non-conversion, and their impact on treatment outcomes, were evaluated using logistic regression models. RESULTS : Of 12,742 total smear-positive PTB cases included in our study, 12.8 % (n = 1627) did not sputum smear convert; 13.3 % (1411 of 10,574) of new cases and 9.9 % (216 of 2168) of re-treatment cases. Although not statistically significant in either new or re-treatment cases, between 2007 and 2013, smear non-conversion decreased from 16.4 to 12.7 % (slope = −0.60; 95 % CI: −1.49 to 0.29; p = 0.142) in new cases, and from 11.3 to 10.8 % in re-treatment cases (slope = −0.29; 95 % CI: −1.06 to 0.48; p = 0.376). Male gender, HIV co-infection and a >2+ acid fast bacilli (AFB) smear grading at the start of TB treatment were independent risk factors for non-conversion (p < 0.001). Age was a risk factor for non-conversion in new cases, but not for re-treatment cases. Non-conversion was also associated with unsuccessful treatment outcomes (p < 0.01), including treatment default and treatment failure. CONCLUSIONS : Smear-positive PTB cases, especially men and those with identified risk factors for non-conversion, should be closely monitored throughout their treatment period. The South African TB control program should invest in patient adherence counselling and education to mitigate TB non-conversion risk factors, and to improve conversion and TB cure rates. | en_ZA |
dc.description.department | School of Health Systems and Public Health (SHSPH) | en_ZA |
dc.description.librarian | hb2016 | en_ZA |
dc.description.sponsorship | This study was supported by PEPFAR funding through CDC South Africa and Foundation for Professional Development. | en_ZA |
dc.description.uri | http://www.biomedcentral.com/bmcinfectdis/ | en_ZA |
dc.identifier.citation | Mlotshwa, M, Abraham, N, Beery, M, Williams, S, Smit, S, Uys, M, Reddy, C & Medina-Marino, A 2016, 'Risk factors for tuberculosis smear non-conversion in Eden district, Western Cape, South Africa, 2007-2013 : a retrospective cohort study', BMC Infectious Diseases, vol. 16, no. 1, Art. #365, pp. 1-12. | en_ZA |
dc.identifier.issn | 1471-2334 | |
dc.identifier.other | 10.1186/s12879-016-1712-y | |
dc.identifier.uri | http://hdl.handle.net/2263/56692 | |
dc.language.iso | en | en_ZA |
dc.publisher | BioMed Central | en_ZA |
dc.rights | © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/). | en_ZA |
dc.subject | Smear non-conversion | en_ZA |
dc.subject | Risk factors | en_ZA |
dc.subject | Treatment outcomes | en_ZA |
dc.subject | Trends | en_ZA |
dc.subject | Tuberculosis (TB) | en_ZA |
dc.subject | South Africa (SA) | en_ZA |
dc.title | Risk factors for tuberculosis smear non-conversion in Eden district, Western Cape, South Africa, 2007-2013 : a retrospective cohort study | en_ZA |
dc.type | Article | en_ZA |
dcterms.description | Additional file 1: Figure S1. Trends in tuberculosis sputum smear non-conversion rate in Eden sub-districts, Western Cape Province, 2007–2013. Chi-square trend for changes in the percentage of TB nonconversion and their respective p values are shown above in the graphs. | |
dcterms.description | Additional file 2: Figure S2. Comparisons of treatment outcome in tuberculosis non-converters and converters of new and re-treatment TB cases. |
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