Association between patient and programmatic characteristics and smear conversion among pulmonary TB patients in South Africa Open Access
Wong, Emily (2012)
Abstract
BACKGROUND: South Africa has one of the worst tuberculosis
epidemics in the
world, with disease rates more than double those observed in other
countries. Evaluation
by sputum smear microscopy after the intensive phase of treatment
is commonly used as
a predictor for treatment outcome. However, little is known about
patient and
programmatic factors that may influence conversion after the
intensive phase or at the
end of treatment.
STUDY OBJECTIVES: To identify patient and programmatic factors
that influence
non-conversion after the intensive phase of treatment and the
association between non-
conversion and other factors and a poor final treatment
outcome.
METHODS: Data previously collected as part of a
national
systematic evaluation aiming to evaluate the TB surveillance system
and Electronic TB
Register (ETR) system in South Africa was used to evaluate the risk
of non-conversion
after the intensive phase of treatment, and poor outcome at the end
of treatment.
RESULTS: The only factor found to be associated with
non-conversion after the
intensive phase was treatment in a rural setting. Factors found to
be associated with poor
outcome were: male gender, treatment in a rural setting, and
receiving directly observed
therapy (DOT) during the intensive phase.
CONCLUSIONS:
These findings help identify simple
predictive factors
that could be used
patients who are less likely to
non-convert after the intensive phase and have poor treatment
outcomes. The results of this
study indicate a need for greater monitoring of patients treated in
rural settings during
both phases of treatment, and males
during the continuation phase of treatment.
Further, more emphasis should be placed on better adherence and
management of DOT.
Future studies should emphasize the need for complete follow-up
results at the end of the
intensive pase.
Association between patient and programmatic characteristics and
smear conversion
among pulmonary TB patients in South Africa
by
Emily Wong
Bachelor of Science
Christian Brothers University
2005
Thesis Committee Chair: Kevin Sullivan, PhD
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfillment of the requirements for the degree of
Master of Public Health in Epidemiology
2012
Table of Contents
Table of Contents
Introduction
....................................................................................................................................
1
Risk factors for failure to convert to negative AFB at 2 or 3
months .......................................... 3
Relationship between conversion and final treatment outcome
................................................... 5
Study Objectives
..........................................................................................................................
9
Methods
.........................................................................................................................................
10
Study Population
........................................................................................................................
10
Data Collection
..........................................................................................................................
11
Variables for Data Analysis
.......................................................................................................
11
Data Coding/Recoding for Analysis
..........................................................................................
14
Statistical Analysis
.....................................................................................................................
15
Ethical Considerations
...............................................................................................................
16
Results
...........................................................................................................................................
18
Study Population
........................................................................................................................
18
Availability of sputum results at the end of the intensive phase of
treatment ........................... 18
Smear conversion
.......................................................................................................................
19
Association between non-conversion to negative AFB smear and final
treatment outcomes ... 20
Discussion
.....................................................................................................................................
22
Conclusions
................................................................................................................................
29
References
.....................................................................................................................................
30
Figures
...........................................................................................................................................
39
Figure 1. Flow chart of patients from three provinces in
South Africa in 2009 included in
analysis of factors related to sputum non-conversion and final
treatment outcome. ................. 39
Tables
............................................................................................................................................
40
Table 1. Comparison of sociodemographic, clinical, and
program characteristics of TB
patients who had a sputum smear collection and result after the
intensive phase...................... 40
Table 2. Patient and programmatic characteristics for the
analytic population of patients who
had a sputum smear collected and a result available for
determination of conversion status at
the end of the intensive phase of treatment
................................................................................
41
Table 3. Univariate association between patient and program
characteristics and sputum
conversion after the intensive phase of TB treatment, among
patients with a sputum smear
result.
..........................................................................................................................................
42
Table 4. Factors significantly associated with
non-conversion to a negative AFB sputum
smear after the intensive phase of treatment in the final
multivariate model............................. 43
Table 5.
Univariate associations between smear conversion status and
patient and program
factors and final treatment outcome, among TB patients with smear
conversion results and final
treatment outcome recorded
.......................................................................................................
44
Table 6. Factors significantly associated with a poor final
treatment outcome in the final
multivariate model.
....................................................................................................................
45
Appendices
....................................................................................................................................
46
Appendix A: South Africa survey evaluation form
...................................................................
46
Appendix B: SAS output for modeling non-conversion & poor
outcome ................................. 57
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