Association between Delay to Treatment Initiation and Treatment Outcomes among Rifampicin Resistant Tuberculosis Patients in Selected Sites in Kenya

Abstract

Drug resistant TB surveillance aims at early detection and treatment of drug resistant tuberculosis to prevent transmission, morbidity and mortality. The delay to Rifampicin Resistant Tuberculosis (RR TB) treatment initiation remains undefined and its association to treatment outcomes unknown. This study sought to determine association between delay in RR TB treatment initiation and treatment outcomes among patients enrolled on treatment between January 2010 and June 2013 in Kenya. A retrospective cohort of 208 RR TB patients were randomly selected and enrolled in the study. Delay was defined as the time from sample collection to treatment initiation calculated in days, which was on the right side of the median. Chi square statistics and logistic regression was done to establish association between delay and treatment outcomes. Multiple logistic regression analysis was conducted to establish factors associated with delay to treatment initiation. Of the 208 participants, 63% (130) were male giving a male to female ratio of 1.7:1. The average age at registration was 34.5 years [95% CI 32.7,36.3] and 26.9% (56) were HIV positive, 95% (53) of them were on ART. Sixty-four percent 64% of the patients were diagnosed based on culture and conventional DST while 36% by GeneXpert. The median time to treatment (delay) was 66 days. The treatment success rate was 82%. The unfavourable outcomes accounted for 18%. The study showed that there is no significant difference between delay or no delay to treatment outcomes as evidenced by chi-square = (0.1858), p =0.666 which is more than 0.05. The female patient was 0.03 times more likely to have unfavourable outcome than the male patient while patients from North Eastern region were 23.5 times more likely than patients from the central region to have unfavourable outcomes. Use of culture and DST for diagnosis of RR TB was significantly associated with delay to treatment initiation. GeneXpert significantly reduces time to treatment initiation compared to culture and DST. Efforts for early diagnosis and treatment should be enhanced to reduce TB transmission and morbidity.