Determinants of Multi Drug Resistant Tuberculosis Treatment Outcomes in Four Counties in Kenya between: 2008-2010

Abstract

Multi drug resistant (MDRTB) is a major clinical challenge, with World Health Organization (WHO) acknowledging it as a threat to global TB control. The number of MDR TB patients is on the rise globally and in Kenya. Since 2006 until 2011, the country reported 692 newly confirmed MDR-TB and 3 XDR TB cases. MDR TB is associated with high morbidity with longer, expensive and more toxic treatment regimens with resultant low cured rates. This study aims at establishing the determinants of MDRTB treatment outcome.

Methods: This was a case control study. Participants were culture confirmed former MDRTB patients who were  started on MDR TB treatment between 1^st January 2008 and 31^st December 2010. Using the national category IV TB register, all eligible patients enrolled were stratified into two: unfavourable and favourable groups, according to MDRTB treatment outcome. Simple random sampling was used to select cases and controls. Data collection was done using a structured interviewer administered questionnaire. Univariate, bi-variate and multivariate analyses were performed on models of predictors.

Results: The total number of drug resistant TB patients diagnosed in CRL between 2008 and 2010 were 516; 346 (67 %) had favourable treatment outcome, 86 (16.7%) defaulted, 69 (13.4%) died while 15 (2.9%) were transferred out. More males 321(62.2%) were affected with drug resistant TB than females. To establish the determinants of unfavourable treatment outcomes, 49 cases and 98 controls were enrolled into the study.  Independent risk factors associated with unfavourable treatment outcome were; having primary or no education [AOR=4.1; 95% CI (1.7-9.8)]; poor housing [AOR=2.6; 95% CI (1.1-6.1)]; and CD4 count less than 200/µl [AOR=14.1; 95% CI (3.8-52.2)]. Taking 30 minutes or less on travelling to, or   waiting for treatment less than at facility [AOR=0.32; 95% CI (0.12-0.83)] and availability of DOTs supporter daily [AOR=0.12; 95% CI (0.o2-0.57)] were found to be protective factors.

Conclusion

Unfavourable MDR TB treatment outcome, is cause by socio-demographic, behavioural, and health related factors. The interaction between the healthcare worker, patient and program factors are key in successful MDR TB treatment which should be decentralized