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Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis

BACKGROUND: Tuberculosis is a global public health problem. Bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients require three sputum smear monitoring (SSM) tests to establish cure or treatment success, but few studies have assessed the relationship. We evaluated the effect of comple...

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Autores principales: Izudi, Jonathan, Tamwesigire, Imelda K., Bajunirwe, Francis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6932753/
https://www.ncbi.nlm.nih.gov/pubmed/31877177
http://dx.doi.org/10.1371/journal.pone.0226919
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author Izudi, Jonathan
Tamwesigire, Imelda K.
Bajunirwe, Francis
author_facet Izudi, Jonathan
Tamwesigire, Imelda K.
Bajunirwe, Francis
author_sort Izudi, Jonathan
collection PubMed
description BACKGROUND: Tuberculosis is a global public health problem. Bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients require three sputum smear monitoring (SSM) tests to establish cure or treatment success, but few studies have assessed the relationship. We evaluated the effect of completing SSM on treatment success rate (TSR) among adult BC-PTB patients in rural eastern Uganda. METHODS: We conducted a propensity score-matched (PSM) analysis of a retrospective observational cohort data. Participants who completed SSM were matched to those who had not, through nearest neighbor 1:1 caliper matching. Balance of baseline characteristics between the groups was compared before and after PSM using standardized mean differences. Logistic regression analysis was performed in matched and unmatched samples, reported as odds ratio (OR) with 95% confidence intervals (CI). Robustness of the results to hidden bias was checked through sensitivity analysis. The primary outcome was TSR (treatment completion or cure), while the secondary was cure rate, measured as an individual outcome. RESULTS: Before PSM, 591 (72.3%) of the 817 participants had incomplete SSM, with statistically significant differences in baseline covariates between completers and non-completers. After PSM, there were 185 participants in either group, balanced on baseline covariates. Before PSM, SSM completion was not associated with TSR, with unadjusted (OR, 0.92; 95%CI, 0.32–2.63) and adjusted analysis (Adjusted OR, 1.32; 95%CI, 0.41–4.22). For cure rate, there was a statistically significant effect before (OR, 93.34; 95%CI, 29.53–295.99) and after adjusted analysis (Adjusted OR, 86.24; 95%CI, 27.05–274.94), although imprecise. In PSM analysis, SSM completion was associated with increased odds of cure (OR, 87.00; 95%CI, 12.12–624.59) but not TSR (OR, 1.67; 95%CI, 0.40–6.97). CONCLUSIONS: Completing SSM increases cure but has no effect on TSR among adult BC-PTB patients in eastern Uganda. Implementation of SSM should be encouraged to ensure improvement in cure rates among tuberculosis patients in rural areas.
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spelling pubmed-69327532020-01-07 Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis Izudi, Jonathan Tamwesigire, Imelda K. Bajunirwe, Francis PLoS One Research Article BACKGROUND: Tuberculosis is a global public health problem. Bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients require three sputum smear monitoring (SSM) tests to establish cure or treatment success, but few studies have assessed the relationship. We evaluated the effect of completing SSM on treatment success rate (TSR) among adult BC-PTB patients in rural eastern Uganda. METHODS: We conducted a propensity score-matched (PSM) analysis of a retrospective observational cohort data. Participants who completed SSM were matched to those who had not, through nearest neighbor 1:1 caliper matching. Balance of baseline characteristics between the groups was compared before and after PSM using standardized mean differences. Logistic regression analysis was performed in matched and unmatched samples, reported as odds ratio (OR) with 95% confidence intervals (CI). Robustness of the results to hidden bias was checked through sensitivity analysis. The primary outcome was TSR (treatment completion or cure), while the secondary was cure rate, measured as an individual outcome. RESULTS: Before PSM, 591 (72.3%) of the 817 participants had incomplete SSM, with statistically significant differences in baseline covariates between completers and non-completers. After PSM, there were 185 participants in either group, balanced on baseline covariates. Before PSM, SSM completion was not associated with TSR, with unadjusted (OR, 0.92; 95%CI, 0.32–2.63) and adjusted analysis (Adjusted OR, 1.32; 95%CI, 0.41–4.22). For cure rate, there was a statistically significant effect before (OR, 93.34; 95%CI, 29.53–295.99) and after adjusted analysis (Adjusted OR, 86.24; 95%CI, 27.05–274.94), although imprecise. In PSM analysis, SSM completion was associated with increased odds of cure (OR, 87.00; 95%CI, 12.12–624.59) but not TSR (OR, 1.67; 95%CI, 0.40–6.97). CONCLUSIONS: Completing SSM increases cure but has no effect on TSR among adult BC-PTB patients in eastern Uganda. Implementation of SSM should be encouraged to ensure improvement in cure rates among tuberculosis patients in rural areas. Public Library of Science 2019-12-26 /pmc/articles/PMC6932753/ /pubmed/31877177 http://dx.doi.org/10.1371/journal.pone.0226919 Text en © 2019 Izudi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Izudi, Jonathan
Tamwesigire, Imelda K.
Bajunirwe, Francis
Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis
title Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis
title_full Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis
title_fullStr Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis
title_full_unstemmed Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis
title_short Does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural Eastern Uganda? A propensity score-matched analysis
title_sort does completion of sputum smear monitoring have an effect on treatment success and cure rate among adult tuberculosis patients in rural eastern uganda? a propensity score-matched analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6932753/
https://www.ncbi.nlm.nih.gov/pubmed/31877177
http://dx.doi.org/10.1371/journal.pone.0226919
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