Clinical response of tuberculosis patients, a prospective cohort study

Abstract

Clinical response means a response to drug intake that can be detected and appreciated by a change in signs and symptoms. The objectives of this study were to assess time to clinical response, the incidence density for clinical response and determinants of clinical response of tuberculosis (TB) patients in the intensive phases of TB treatment. Prospective cohort study design was implemented. The target population for this study was all patients following the directly observed therapy. Baseline data has been collected during the start of the directly observed TB treatment strategy. We have been collected updated data after the seven days of the baseline data collection, then after every seven days updated data has been collected from each pulmonary and extra pulmonary TB patients. Kaplan Meier curve was used to estimate time to clinical response. Incidence density using person days was used to estimate incidence of clinical response. Cox proportional hazard model was used to identify the predictors of clinical responses. A total of 1608 TB patients were included with a response rate at 99.5%. The mean age of the respondents was 24.5 years [standard deviation (SD) 14.34 years]. The incidence density for clinical response was 1429/38529 person days. One fourth of the TB patients showed clinical response at day 14, 25% of at day 21 and 75% o at day 31. Predictors of clinical response for TB patients includes: age (AHR 1.007 [95% CI 1.003–1.011]), type of TB (AOR 2.3[95% CI 2.04–2.59]), Previous history of TB (AHR 0.18 [95% CI 0.11–0 .30]), Intestinal parasitic infection (AOR 0.22[95% CI 0.19–0.26]), hemoglobin (AOR 2.35 [95% CI 2.18–2.54]), weight gain (AOR 1.11 [95% CI 1.05–1.17]), Micronutrient supplementation (AOR 9.71 [95% CI 8.28–11.38]), male sex (AOR 0.87 [95% CI 0.79–0.97]).The clinical responses for extra-pulmonary TB patients were slower than pulmonary TB. Deworming and micronutrient supplementation should be considered as the additional TB treatment strategy for TB patients.