Abstract
Zimbabwe is one of the 30 countries globally with a high burden of multidrug-resistant TB or rifampicin-resistant TB (MDR/RR). The World Health Organization (WHO) recommended that patients diagnosed with MDR/RR-TB be treated with 20-24 month standardized second-line drugs (SLDs) since 2010. However factors associated with mortality and treatment success have not been systematically evaluated in Zimbabwe. To assess factors associated with Mortality and treatment success among MDR/RR-TB patients registered and treated under the National Tuberculosis programme in Zimbabwe between January 2010 and December 2015. A retrospective, secondary analysis of the routinely collected data was conducted. In Zimbabwe, TB and DRTB are notifiable diseases and the National TB Programme (NTP) maintains national case registration files on site of all patients initiated on treatment in all notification centres. Despite existing efforts to control MDR TB deaths in the country, the overall mortality rate in this study was 38.90% ; thus in every 100 TB patients approximately 39 die. The relative risk ratio estimates of MDR/RR-TB treatment failure was distributed as follows: Not recorded Culture conversion period (RRR 1.75, p=0.018; ≤ 10% missed TB treatment doses had RRR=4.75, p <0.001, >10% missed doses (RRR = 9.28, p <0.001); Comorbidity (RRR=1.44, p=0.02); patient ART status was a significant associated factor of treatment success or failure (RRR=3.92, p<0.001). Patients who were not on ART had a high risk of death by 3.92 times compared to patients who were on ART. The findings show evidence of suboptimal MDR/RR-TB treatment success rates in this largely HIV co-infected patient population mainly due to longer culture conversion period, high magnitude of >10% missed doses, poor monitoring of patients due to incomplete documentation, prevalent comorbidities, missed ART opportunities i.e. Patients who were HIV positive and not on ART were more likely to die as compared to patients who were HIV positive and on ART. Being not on ART when HIV positive was a major significant predictor of mortality. Improving ART uptake among those ART-naïve and strategies aimed at improving treatment adherence are important in improving treatment success rates. Future studies should focus on profiling management of MDR/RR-TB patients accessing care at the primary level health care facilities in this setting.
