SURVIVAL AND PREDICTORS OF MORTALITY AMONG PATIENTS UNDER MULTI-DRUG RESISTANT TUBERCULOSIS TREATMENT IN ETHIOPIA: ST. PETER’S SPECIALIZED TUBERCULOSIS HOSPITAL, ETHIOPIA

摘要

Background: Multi-drug resistance tuberculosis (MDR-TB) is an increasing global problem. The extent and burden of MDR-TB varies significantly from country to country. Survival of MDR-TB treatment is not described in Ethiopia. Therefore, examining a cohort who received second-line therapy for MDR-TB to determine overall survival has a great importance. Objectives: To assess survival and predictors of mortality among patients under MDR-TB treatment in Ethiopia: St Peter’s specialized TB Hospital, Addis Ababa, Ethiopia. Methods: A retrospective analysis of records was conducted from Oct, 2011 – May, 2012 among cohorts of MDR-TB patients in St. Peter’s specialized TB hospital?that starts treatment from February 2009 . Data were collected using checklist from 188 patients’ record that is determined and analyzed using the STATA Statistical package, Version 11.0. Risk was estimated for the entire follow-up time corresponding to each event occurrence using Kaplan-Meier method and the covariates are fitted to Cox proportional hazard regression model. Result: The 188 patients were followed for a total of 79,600 person-days. Median follow up time was 466.5 days or 1.28 years. Among the total subjects, 87 (46.28%) are male and the rest 101 (53.72%) are female with a median age of 27 years. There were 29 (15.43 %) known deaths (incidence rate: 3.6 per 10,000 person-days). Survival rate at 6, 12, 18, and 24 months of treatment were 88.53 %, 85.83 %, 82.71 % and 78.95 % respectively. The mean survival time for patients under MDR-TB was 9.7 years. Comparison of the groups showed that there is a significant difference in the probability of surviving between HIV status, smoking status, therapeutic delay, No. of first line resistantdrugs at initiation, co-morbidities, region and clinical complication. In multivariate Cox proportional hazard regression, factors independently associated with mortality of patients were smoking (HR: 4.01, 95% CI 1.42 – 11.37, P = 0.009), therapeutic delay > 1 month (HR: 3.61, 95% CI 1.41 – 9.20, P = 0.007), HIV seropositive (HR: 5.94, 95% CI 2.40 – 14.72, P P < 0.001). Conclusion and recommendation: Survival of patients was higher and higher hazard of death was noted in patients who started treatment after a month, smoker, HIV positive and patients who develop a clinical complication. Although survival is good, reinforcing the existing treatment program will further improve patients’ survival in Ethiopia.