Key Factors Influencing Tuberculosis Treatment Success in Ghana

Tuberculosis (TB) is a serious health issue around the world, affecting over 10 million people each year. Despite being a disease that can be prevented and treated, TB remains the second deadliest illness globally, just after COVID-19. In 2021 alone, TB caused about 1.5 million deaths. Most cases are found in low- and middle-income countries, particularly in regions like South-East Asia, Africa, and the Western Pacific. In Ghana, for instance, around 136 TB cases were reported for every 100,000 people in 2021, leading to roughly 12,000 deaths from TB alone, along with additional deaths related to HIV.

The COVID-19 pandemic has had a negative impact on healthcare services, worsening the situation for TB treatment in many areas. The success rates of TB treatment can vary greatly from country to country. As of 2020, the global average for successful TB treatment was 85%, which is below the goal of 90% set for 2025. In the United States, the success rate was 74%, while it averaged 79% in Africa. Poor treatment outcomes for drug-susceptible TB remain a significant challenge worldwide.

In Ghana, despite the availability of free TB treatment, the mortality rate from the disease is still a problem. Since 2012, the success rate for TB treatment in Ghana has remained around 84-85%, below the target recommended by the World Health Organization (WHO). Research conducted in various regions of Ghana shows different treatment success rates: 82.5% in Volta, 90.2% in Central, and 90.7% in Greater Accra. Improving treatment success is critical for the National Tuberculosis Control Program (NTP) as it can help reduce costs, lower morbidity, and save lives.

Several factors contribute to the poor treatment outcomes for TB, especially in low- and middle-income countries. These include limited access to healthcare resources, patients not sticking to their treatment plans, HIV co-infection, substance abuse, and lack of social support. Other studies have pointed out issues like stigma surrounding TB, low levels of awareness about the disease, and poor living conditions such as overcrowded housing and malnutrition as factors that worsen treatment outcomes.

Success in treating tuberculosis is influenced by many factors related to patients’ demographics, health, and social circumstances. Elements like low income, substance abuse, gender, education, unemployment, older age, being part of migratory communities, and stigma can all affect how well TB treatment works. Identifying what causes low treatment success is essential for health officials and policymakers.

Many studies have looked into what leads to low treatment success rates in Ghana. However, much remains to be done. While some factors like age and weight before treatment have been noted, there is still a great need for more research to understand these issues fully. Most existing studies have not yet examined how the quality of life and side effects from TB medication impact treatment outcomes. Therefore, more in-depth studies are needed to tackle these factors, which will help create more effective ways to improve TB treatment success in Ghana and similar areas. This research aims to assess treatment outcomes and find out what factors influence success in patients with drug-sensitive TB, considering how side effects from medication and overall quality of life affect results.

#Study Design and Participants

The study took place in the Eastern and Ashanti Regions of Ghana, specifically at eight TB treatment centers. These centers were selected for consistently reporting high TB case numbers over the last five years. The research involved three primary care hospitals and one regional referral hospital. Participants included newly diagnosed TB patients ready to start treatment. Only those aged 18 or older, with a mobile phone, and who agreed to participate were included. People with severe Mental Health issues or liver or kidney problems were not part of the study.

To ensure strong statistical analysis, a minimum of 128 participants were needed. However, to account for non-responses and ensure diversity, 378 people were recruited for the study.

#Data Collection and Analysis

Data collection was done using a tool developed with REDCap. The tool was checked for reliability and adjusted based on a pretest. Participants were recruited and data collected from January 10, 2021, to April 15, 2022. Trained assistants contacted patients weekly to check for side effects from their TB treatment. Any side effects noted at the clinic were also recorded. The Naranjo Scale was used to determine if reported side effects were connected to the TB drugs.

Participants’ quality of life was measured using the Short Form 12 version 2 (SF-12v2) survey. This survey assesses various aspects of well-being and is commonly used in chronic illness contexts. Changes in the scores at the end of treatment were analyzed, with a minimum increase of 3 points in scores considered clinically important. Participants with mental health scores below a specific point were noted as experiencing depression.

The data was cleaned and analyzed using Microsoft Excel and IBM SPSS Statistics. Results were presented as frequencies and percentages, while statistical tests were used to find links between patient characteristics and treatment success. The significance threshold was set at 0.05.

#Ethical Considerations

The study followed ethical guidelines and received approval from two committees. Ethical principles included voluntary participation, ensuring participants were informed and could withdraw at any time without needing to justify their decision.

#Participant Demographics

Of the 378 participants, most were male (67.2%), married (44.2%), and employed (75%), with an average age of 45.3 years. About 12.9% were illiterate, and 6.1% had extrapulmonary TB, while 6.4% were smokers, 25.4% consumed alcohol, and 25.7% were HIV-positive.

#Treatment Outcomes

Among the participants, 44.2% were cured, 33.1% completed their therapy, 13.5% were lost to follow-up, 8.7% died, and 0.5% were classified as treatment failures. This gives an overall treatment success rate of 77.3%.

Gender did not significantly affect treatment success, as 78.7% of males and 74.2% of females successfully completed treatment. However, those with a baseline weight of at least 53 kg had a higher success rate of 83.6% compared to 72.6% for those with less weight. Participants who gained at least 3 kg during treatment had a success rate of 90.9%, while those who gained less than that had a success rate of 65.5%.

People who tested negative for HIV had a higher success rate of 81.8%, compared to 64.9% for those who were HIV-positive. Additionally, the type of TB infection mattered; those with extrapulmonary TB had a 100% success rate, while those with pulmonary TB had a 75.4% success rate.

#Relationship Between Patient Factors and Treatment Success

The presence of side effects from TB medications did not significantly change success rates. The rates were similar for those with and without adverse reactions. However, those in good physical health had a success rate of 88.8% compared to 74.2% for those in poor health, indicating that overall health is crucial.

Mental health also played a role, as those who were mentally well achieved an 80.2% success rate, while those who struggled mentally had a lower success rate of 69.1%.

#Key Determinants of Treatment Success

The study highlighted several key factors that significantly influenced treatment outcomes: baseline weight, Weight Gain during treatment, HIV status, and mental and physical health.

Participants with a weight above 53 kg were nearly twice as likely to achieve successful treatment compared to those below that weight. Those gaining at least 3 kg during treatment had even higher odds of success. HIV-negative individuals had more than double the odds of achieving successful treatment compared to those who were HIV-positive. Physical and mental health also matters; those in good shape were three times more likely to succeed, and those without depression were nearly twice as likely to have a successful outcome.

Although there was no significant link between adverse reactions and treatment success, participants without gastrointestinal side effects had twice the odds of success compared to those who did, and those without liver-related reactions had nearly 22 times the odds of success.

#Conclusion

In summary, several important factors affect TB treatment outcomes. These include a patient's weight, whether they gained weight during treatment, their HIV status, and their mental and physical state. Addressing these aspects can help healthcare providers improve treatment success rates and ultimately help combat tuberculosis more effectively.