IJID Regions 10 (2024) 9–14 Contents lists available at ScienceDirect IJID Regions journal homepage: www.elsevier.com/locate/ijregi Evaluation of treatment outcomes among adult patients diagnosed with tuberculosis in Ghana: A 10 year retrospective review Peter Puplampu 1 , 2 , ∗ , Isaac Kyeremateng 3 , Olive Asafu-Adjaye 4 , Anita Ago Asare 2 , 5 , Kofi Agyabeng 6 , Roderick Sarkodee 2 , Oladele Oluwakemi 2 , Vincent Ganu 2 1 Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana 2 Infectious disease unit, Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana 3 Ghana Health Service, Accra, Ghana 4 Greater Accra Regional Hospital, Accra, Ghana 5 Department of Community Health, University of Ghana Medical School, Accra, Ghana 6 Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana a r t i c l e i n f o Keywords: Tuberculosis Outcome Extra-pulmonary Clinically diagnosed Treatment success rate a b s t r a c t Objectives: The study determined tuberculosis (TB) treatment outcomes in Southern Ghana from 2012 to 2021. Methods: A retrospective analysis of service data on TB cases was conducted. Treatment success was defined as TB cure or completion of treatment course, whereas unsuccessful outcomes was defined as death, failure of treatment and lost to follow up. Bivariate and multivariate logistic regression was used to determine factors associated with treatment outcomes. Results: A total of 4106 adult TB cases were reported with a median age of 41 (interquartile range 32-52) years. Of these, 93.1% (n = 3823) were newly diagnosed. The treatment success rate declined from 71.0% in 2012 to 55.7% in 2021 (ktau-b = − 0.56, P = 0.0318). Clinically diagnosed TB and extra-pulmonary TB had 7.0% (adjusted prevalence ratio [aPR]: 0.93, 95% confidence interval [CI]: 0.88-1.00) and 24.0% (aPR: 0.76, 95% CI: 0.69-0.84) respectively, less successful treatment outcome compared to pulmonary TB patients. HIV negative status was associated with 22% higher successful treatment outcome compared with being HIV positive (aPR: 1.22, 95% CI: 1.12-1.33). Conclusion: Tuberculosis treatment success rate declined over the period. There is a need for the TB Control Programme to review the national and sub-national TB data to ascertain poor performing TB treatment sites to identify and address context specific challenges with treatment interventions and system inadequacies to improve treatment success rates. I ( w p i i E t y w i c a r r h S f a a a T a o h R 2 B ntroduction An estimated 10.6 million people were affected with tuberculosis TB) worldwide with a total of 1.6 million people (including 214,000 ith HIV) dying of this infectious disease in 2021 [1] . The majority of ersons with TB live in Asia and Africa [1] . The 2021 Global TB report ndicates a decline in the number of TB cases reported with an increase n TB-related deaths at all levels, falling short of the targets set in the nd TB strategy 2015-2035. The End TB targets for 2035 are to reduce he TB incidence rate by 90% to ≤ 10 cases per 100,000 population per ear and to reduce the absolute number of TB deaths by 95% compared ith a baseline of 2015 [1] . Successful treatment of TB is necessary n reducing deaths and other complications especially in high burden ountries across Asia and Africa. ∗ Corresponding author. E-mail addresses: pedpup@yahoo.com , pedpup2@gmail.com (P. Puplampu) . ttps://doi.org/10.1016/j.ijregi.2023.11.004 eceived 5 August 2023; Received in revised form 5 November 2023; Accepted 6 No 772-7076/© 2023 The Author(s). Published by Elsevier Ltd on behalf of Internation Y license ( http://creativecommons.org/licenses/by/4.0/ ) Globally, though treatment success rates (TSR) have remained rel- tively stable across all ages, TSR has still fallen short of the 90% rate ecommended by the World Health Organization (WHO) [1,2] . TSR also emain lower in people living with HIV (PLHIV) though some progress ave been made overtime [1] . Treatment success rates reported for Sub- aharan Africa range from 69-94% [1] . Proposed predictors of success- ul TB treatment reported include the female sex, HIV-negative status nd being of a young age [3–7] . HIV infection, socioeconomic factors, dverse reactions from TB drugs, undernutrition, alcohol abuse and old ge have been noted to be risk factors for poor outcomes in persons with B infection [5,8,9] . Ghana is a country with a high burden TB/HIV with TB being ranked s the seventh top cause of mortality in Ghana accounting for 4.9% f all deaths in 2019 [10,11] . The prevalence of TB incidence by mi- vember 2023 al Society for Infectious Diseases. This is an open access article under the CC https://doi.org/10.1016/j.ijregi.2023.11.004 http://www.ScienceDirect.com http://www.elsevier.com/locate/ijregi http://crossmark.crossref.org/dialog/?doi=10.1016/j.ijregi.2023.11.004&domain=pdf mailto:pedpup@yahoo.com mailto:pedpup2@gmail.com https://doi.org/10.1016/j.ijregi.2023.11.004 http://creativecommons.org/licenses/by/4.0/ P. Puplampu, I. Kyeremateng, O. Asafu-Adjaye et al. IJID Regions 10 (2024) 9–14 c w 3 W fi t c r i 2 a M S 2 T m o S a a 2 D e a O f t D c S p t n f m c u o S m f m b i m s R t i T m p ( m T ( a ( d g t t O r 2 T o t H T c c m d a H c 2 roscopy was 111/100,000 and that of bacteriologically confirmed TB as 356/100,000 in 2013 [12] . The TB case detection rate in Ghana is 4% which is very low compared to the WHO set target of 80% [13–15] . ith a low rate of TB case detection, it is important to ensure identi- ed TB patients complete treatment and are cured. Evaluation of TB reatment outcomes is key to ensure that patients do not go back into ommunities to infect others and also reduce the risk of developing drug esistant TB. The WHO recommends that all countries monitor their progress us- ng the high-level indicators/targets set in the End TB strategy 2015- 035 [1] . This study sought to determine TB treatment outcomes over 10-year period, 2012 to 2021 in southern Ghana. ethods tudy design and settings A facility-based retrospective study of TB cases treated from January 012 to December 2021 was conducted at the TB unit of the Korle-Bu eaching Hospital (KBTH) in Accra Ghana. The TB unit serves as the ain referral center for the management of TB in Southern Ghana. It ffers both in- and out-patient services. tudy participants Study participants were patients 18 years and above with clinical nd microbiological diagnosis of drug-sensitive TB who were registered nd initiated on anti-TB treatment between January 2012 to December 021. ata source and extraction Data were extracted from the TB register using a standardized data xtraction form that included information on socio-demographic vari- bles, medication-related factors, and treatment result. utcome measures and definitions Definitions of outcome measures for this study were as per WHO TB ramework [16] . The TB treatment outcome measures and their defini- ions are as below: Cured : A pulmonary TB patient with bacteriologically confirmed TB at the beginning of treatment who was smear- or culture-negative in the last month of treatment and on at least one previous occa- sion. Completed : A TB patient who completed treatment without evidence of failure BUT with no record to show that sputum smear or cul- ture results in the last month of treatment and on at least one previous occasion were negative, either because tests were not done or because results are unavailable. Treatment success : The sum of cured and treatment completed. Failure: A TB patient whose sputum smear or culture is positive at month 5 or later during treatment. Death: A TB patient who dies for any reason before starting or during the course of treatment. Lost to follow-up: A TB patient who did not start treatment or whose treatment was interrupted for 2 consecutive months or more. Not evaluated: A TB patient for whom no treatment outcome is as- signed. This includes cases “transferred out ” to another treatment unit as well as cases for whom the treatment outcome is unknown to the reporting unit. ata handling and analysis Extracted data were entered into Microsoft Excel spreadsheet for leaning and coding then imported into Stata version 16 for analysis. 10 ummary statistics of categorical characteristics of patients were re- orted as frequencies and percentages while the median and interquar- ile ranges were reported for the continuous variables that were not ormally distributed. Chi-square test of independence was used to test or association between categorical independent variables and TB treat- ent outcome. Line graph was used in exhibiting the distribution of TB ases treated and treatment outcomes over time. Mann-Kendall test was sed in testing for the significance of trends in the treatment outcome f the study period. The treatment result was classified into two groups: uccessful treatment outcomes (which comprised of “Cured ” and “Treat- ent completed ”.) and unsuccessful treatment outcomes ( “treatment ailure ”, “died ” and “lost to follow up ”). Modified Poisson regression odel with robust standard error was used in quantifying the effect of etween successful TB treatment outcomes and the patients character- stics on successful TB treatment outcomes. Binary logistic regression odels with robust standard errors was used as sensitivity analysis. All tatistical analysis were done at 5% level of significance. esults Patients treated for TB at the TB Unit from 2012 to 2021 were a otal of 4623. Of this, 4453 (96.3%) were aged 18 years and above were ncluded in the study. Out of the 4453, 196 were transferred out of the B unit so were excluded and an additional 151 were excluded due to issing or repeated entries. A total of 4106 patients with TB were included in this study. Study articipants were aged 18 years to 110 years with a median age of 41 interquartile range 32-52) years ( Table 1 ). Most of the patients were ales (63.4%, n = 2605). More than half (52.6%, n = 2159) of the B cases were pulmonary TB (PTB) cases (bacteriologically diagnosed PTB + ) - 34.6% (n = 1420) and clinically diagnosed TB 18% (n = 739)) nd 47.2% (n = 1940) of them were extrapulmonary TB (EPTB) cases Table 1 ). About nine in every ten sampled cases studied were newly iagnosed 93.0% (n = 3823). From the chest x-ray findings, 81.0% (n = 3324) of cases were sug- estive of TB. For 29.2% (n = 1199) of all TB cases, more than half of he patients were HIV negative (53.8%, n = 2208). Majority (57.9%, n = 2877) of the treated patients had successful reatment outcome (completed and cured) ( Table 1 and Figure 1 ). verall trend in treatment success rates From Table 1 , the overall TSR averaged 57.9% over the 10-year pe- iod. The TSR declined significantly from 71.0% in 2012 to 55.7% in 021 (ktau-b = − 0.56, P -value = 0.0318) ( Figure 2 ). rend in tuberculosis treatment success rates by HIV status Although there was a generally decreasing trend in the proportion f successful treatment outcomes among the patients, HIV negative pa- ients recorded consistently higher successful treatment outcomes than IV positive patients ( Table 2 ). uberculosis treatment outcomes by sociodemographic and clinical haracteristics The proportion of successful treatment outcome decreased signifi- antly with increase in age ( P -value < 0.001) ( Table 3 ). Among the ales, 45.3% (n = 1180) completed the treatment, 31.8% (n = 828) ied, 13.6% (n = 355) were cured, 8.2% (n = 213) lost to follow-up, nd 1.1% (n = 29) had treatment failure. Among the patients who tested IV + , 46.6% (n = 326) completed the treatment, 7.0% (n = 49) were ured 38.5% (n = 269) died, 7.2% (n = 50) were lost to follow-up and .5% (n = 36) had treatment failure. P. Puplampu, I. Kyeremateng, O. Asafu-Adjaye et al. IJID Regions 10 (2024) 9–14 Table 1 Sociodemographic and clinical characteristics of the notified TB cases (n = 4106) among adult patients at the Chest Unit of the Korle-Bu Teaching Hospital from 2012 to 2021. Characteristics 2012 N(%) 2013 N(%) 2014 N(%) 2015 N (%) 2016 N (%) 2017 N (%) 2018 N (%) 2019 N (%) 2020 N (%) 2021 N (%) Total N (%) All cases of TB treated 514 267 560 433 469 465 378 375 358 287 4106 Age group 18-34 183(35.6) 86(32.2) 192(34.3) 117(27.0) 128(27.3) 162(34.8) 117(31.0) 116(30.9) 118(33.0) 91(31.7) 1310(31.9) 35-64 295(57.4) 160(59.9) 329(58.8) 275(63.5) 289(61.6) 257(55.3) 237(62.7) 222(59.2) 207(57.8) 168(58.5) 2439(59.4) 65 + 36(7.0) 21(7.9) 39(7.0) 41(9.5) 52(11.1) 46(9.9) 24(6.3) 37(9.9) 33(9.2) 28(9.8) 357(8.7) Median age (Lower quartile – upper quartile) 40(31-52) 41(32-51) 40(32-50) 42(34-53) 42(34-53) 42(30-53) 42.5(32-52) 42(32-54) 41(31-51) 44(31-55) 41(32-52) Sex Male 322(62.6) 165(61.8) 347(62.0) 284(65.6) 302(64.4) 292(62.8) 245(64.8) 218(58.1) 241(67.3) 189(65.9) 2605(63.4) Female 192(37.4) 102(38.2) 213(38.0) 149(34.4) 167(35.6) 173(37.2) 133(35.2) 157(41.9) 117(32.7) 98(34.1) 1501(36.6) Diagnostic classification Pulmonary TB + 175(34.0) 99(37.1) 179(32.0) 138(31.9) 140(29.9) 129(27.7) 105(27.8) 151(40.3) 159(44.4) 145(50.5) 1420(34.6) Clinically diagnosed TB 128(24.9) 66(24.7) 122(21.8) 84(19.4) 94(20.0) 72(15.5) 54(14.3) 46(12.3) 37(10.3) 36(12.5) 739(18.0) Extra pulmonary TB 210(40.9) 102(38.2) 259(46.3) 211(48.7) 232(49.5) 264(56.8) 219(57.9) 178(47.5) 162(45.3) 103(35.9) 1940(47.2) Not documented 1(0.2) - - - 3(0.6) - - - - 3(1.0) 7(0.2) Type of patient New 469 (91.2) 247(92.5) 517 (92.3) 405(93.5) 444(94.7) 444(95.5) 357(94.4) 354(94.4) 335(93.6) 251(87.5) 3823 (93.1) Other 45 (8.8) 20 (7.5) 43 (7.7) 28 (6.5) 25 (5.3) 21 (4.5) 21 (5.6) 21 (5.6) 23 (6.4) 36 (12.5) 283 (6.9) HIV status Negative 271 (52.7) 134 (50.2) 284 (50.7) 239 (55.2) 225 (48.0) 257 (55.3) 229 (60.6) 196 (52.3) 201 (56.1) 172 (59.9) 2208 (53.8) Positive 100 (19.5) 47(17.6) 74 (13.2) 59 (13.6) 89 (19.0) 77 (16.6) 69 (18.3) 88 (23.5) 55 (15.4) 41 (14.3) 699 (17.0) Not documented 143 (27.8) 86 (32.2) 202 (36.1) 135 (31.2) 155 (33.0) 131 (28.2) 80 (21.2) 91 (24.3) 102 (28.5) 74 (25.8) 1199 (29.2) Chest x-ray findings Suggestive 444 (86.4) 243(91.0) 498 (88.9) 380(87.8) 322(68.7) 365(78.5) 315(83.3) 306(81.6) 279(77.9) 172(59.9) 3324 (81.0) Not suggestive 46 (8.9) 11 (4.1) 39 (7.0) 15 (3.5) 103(22.0) 34 (7.3) 20 (5.3) 33 (8.8) 30 (8.4) 17 (5.9) 348 (8.5) Unknown 1 (0.2) 1 (0.4) 1 (0.2) - 1 (0.2) 2 (0.4) - 1 (0.3) - - 7 (0.2) Not documented 23 (4.5) 12 (4.5) 22 (3.9) 38 (8.8) 43 (9.2) 64 (13.8) 43 (11.4) 35 (9.3) 49 (13.7) 98 (34.1) 427 (10.4) Treatment outcomes Completed 303(58.9) 126 (47.2) 235 (42.0) 176 (40.6) 199 (42.4) 208 (44.7) 182 (48.1) 170 (45.3) 151 (42.2) 134 (46.7) 1884 (45.9) Cured 62 (12.1) 49 (18.4) 81 (14.5) 52 (12.0) 49 (10.4) 60 (12.9) 37 (9.8) 39 (10.4) 38 (10.6) 26 (9.1) 493 (12.0) Died 134 (26.1) 84 (31.5) 185(33.0) 172(39.7) 179(38.2) 157(33.8) 119(31.5) 105(28.0) 118(33.0) 83(28.9) 1336 (32.5) Failure 9 (1.8) 4 (1.5) 8 (1.4) 5 (1.2) 3 (0.6) 3 (0.6) 1 (0.3) 3 (0.8) 2 (0.6) 3 (1.0) 41 (1.0) Lost to follow-up 6 (1.2) 4 (1.5) 51 (9.1) 28 (6.5) 39 (8.3) 37 (8.0) 39 (10.3) 58 (15.5) 49 (13.7) 41 (14.3) 352 (8.6) Overall treatment Successful 365 (71.0) 175(65.5) 316 (56.4) 228(52.7) 248(52.9) 268(57.6) 219(57.9) 209(55.7) 189(52.8) 160(55.7) 2377 (57.9) Unsuccessful 149 (29.0) 92 (34.5) 244 (43.6) 205(47.3) 221(47.1) 197(42.4) 159(42.1) 166(44.3) 169(47.2) 127(44.3) 1729 (42.1) TB, tuberculosis; %; column % Figure 1. Trend in tuberculosis treatment outcomes among adult patients at the Chest Unit of the Korle-Bu Teaching Hospital from 2012 to 2021. F s c 0 o fi 0 t s m actors associated with treatment outcomes From both the adjusted modified Poisson and binary logistic regres- ion models, age, diagnostic classification, and HIV status were signifi- antly associated the successful patients treatment outcome ( P -value < .05). The prevalence/ proportion of patients with successful treatment 11 utcome were 13.0% (adjusted prevalence ratio [aPR]: 0.87, 95% con- dence interval [CI]: 0.83-0.92), and 32.0% (aPR: 0.68, 95% CI: 0.59- .79) lower among patients aged 35-64 years and 65 + years compared o patients aged 18-34 years old respectively ( Table 3 ). HIV negative tatus was associated with 22.0% higher proportion of successful treat- ent outcome compared with being HIV positive (aPR: 1.22, 95% CI: P. Puplampu, I. Kyeremateng, O. Asafu-Adjaye et al. IJID Regions 10 (2024) 9–14 Figure 2. Trend of proportion of successful treatment outcomes among the adult patients at the Chest Unit of the Korle-Bu Teaching Hospital from 2012 to 2021. Table 2 Treatment outcomes by sociodemographic and clinical characteristics among adult patients at the Chest Unit of the Korle-Bu Teaching Hospital from 2012 to 2021. Sociodemographic and clinical characteristics Treatment outcomes Completed n(%) Cured n(%) Died n(%) Failure n(%) Lost to follow-up n(%) P -value Age groups 18-34 years 665(50.8) 194(14.8) 307(23.4) 17(1.3) 127(9.7) 35-64 years 1082(44.4) 277(11.4) 871(35.7) 20(0.8) 189(7.7) < 0.001 65 + years 137(38.4) 22(6.2) 158(44.3) 4(1.1) 36(10.1) Sex Male 1180(45.3) 355(13.6) 828(31.8) 29(1.1) 213(8.2) 0.001 Female 704(46.9) 138(9.2) 508(33.8) 12(0.8) 139(9.3) Diagnostic classification Pulmonary TB + 501(35.3) 477(33.6) 305(21.5) 36(2.5) 101(7.1) Clinically diagnosed TB 443(59.9) 7(0.9) 217(29.4) 2(0.3) 70(9.5) < 0.001 Extra pulmonary TB 936(48.2) 8(0.4) 812(41.9) 3(0.2) 181(9.3) HIV status Negative 1058(47.9) 390(17.7) 528(23.9) 31(1.4) 201(9.1) Positive 326(46.6) 49(7.0) 269(38.5) 5(0.7) 50(7.2) < 0.001 Chest x-ray findings Suggestive 1530(46.0) 449(13.5) 1032(31.0) 37(1.1) 276(8.3) Not suggestive 171(49.1) 2(0.6) 135(38.8) - 40(11.5) < 0.001 Unknown 3(42.9) 1(14.3) 2(28.6) - 1(14.3) TB, tuberculosis; %; Row percentage. 1 0 p r D s m n r p o e m t u r w g a r a s i c i [ u i T 9 m 8 7 R T p 2 2 .12-1.33). Clinically diagnosed TB and EPTB patients, had 7.0% (aPR: .93, 95% CI: 0.88-1.00) and 24.0% (aPR: 0.76, 95% CI: 0.69-0.84) less roportion of successful treatment outcome compared to PTB + patients espectively ( Table 3 ). iscussion This study determined the TB trends and treatment outcomes of drug ensitive TB in a tertiary health facility. About 58% had successful treat- ent. The TSR averaged 57.9% over the 10-year period, declining sig- ificantly from 71.0% in 2012 to 55.7% in 2021. HIV-negative patients ecorded consistently higher successful treatment outcomes than HIV- ositive patients. Being HIV-negative was associated with 65% higher dds of successful treatment outcome compared to being HIV-positive. Despite concerted efforts being made by the country with its well- stablished community-based DOTS strategy, TB case reports still do not eet targets set by the WHO. The national TB programm suggested that he drop in case notifications between 2012-2013 was possibly due to nderdiagnosis within the routine system [17] . The drop within the pe- iod of 2020-2021 could likely be due to many causes chief among them ould be a reduction in testing due to the COVID-19 pandemic as seen lobally [1,9] . In addition to this, more male cases were notified glob- 12 lly [1] . Comparable studies across Africa reported a similar significant eduction in TB case notifications with more notifications in men with few reporting a higher burden in women and children [10,11] . De- pite this, as the country strives to improve TB services being offered, it s important that the excess burden experienced by men be taken into onsideration [18] . It has been shown by various studies done within the country that co- nfection with HIV negatively impacts treatment outcomes of TB cases 12–14] . Despite this a significant number of cases in our study have nknown HIV status. This informs that further efforts must be made to mprove HIV testing among persons diagnosed with TB. The TSR declined significantly over the past decade in this study. he TSR of TB patients over the period of 57.9% is much lower than the 0% standard set by the World Health Organization in 2003 and also uch lower than TSR recorded in other parts of the country, including 2.5%- 88.1% [15–17] . It is also lower than that found in Ethiopia of 5.2-88% [19] . However a study done from 2007 to 2017 in the Ashanti egion of Ghana showed a TSR of 68.4% [20] . Unfortunately, the low SR has showed a general downward trend in our study over the time eriod. Successful treatment outcome rates fell from 2019 (55.6%) into 020 (52.9%) at the height of COVID- 19, with rates rising again in 021 (56.3%) as was found generally globally that COVID- 19 had re- P. Puplampu, I. Kyeremateng, O. Asafu-Adjaye et al. IJID Regions 10 (2024) 9–14 Table 3 Factors associated with the overall treatment outcomes among adult patients at the Chest Unit of the Korle-Bu Teaching Hospital from 2012 to 2021. Treatment outcome Unadjusted modified Poisson regression model Adjusted modified Poisson regression model Adjusted binary logistic regression model Characteristics Successful Unsuccessful P -value n (%) n (%) Unadjusted PR (95% CI) P -value Adjusted PR (95% CI) P -value Adjusted odds ratio (95% CI) P -value Age group < 0.001 < 0.001 < 0.001 < 0.001 18-34 859 (65.6) 451(34.4) 1 1 1 35-64 1359(55.7) 1080(44.3) 0.85(0.81-0.90) < 0.001 0.87(0.83-0.92) < 0.001 0.69(0.58-0.82) < 0.001 65 + 159(44.5) 198(55.5) 0.69(0.61-0.78) < 0.001 0.68(0.59-0.79) < 0.001 0.40(0.30-0.55) < 0.001 Sex 0.077 0.074 0.834 0.857 Male 1535(58.9) 1070(41.1) 1 1 1 Female 842(56.1) 659(43.9) 0.95(0.90-1.00) 1.00(0.96-1.04) 0.99(0.89-1.10) Type of patient 0.012 0.004 0.364 0.330 New 2193(57.4) 1630(42.6) 1 1 1 Other 184(65.0) 99(35.0) 1.13(1.04-1.23) 1.02(0.98-1.06) 1.07(0.93-1.22) Diagnostic classification < 0.001 < 0.001 < 0.001 < 0.001 Pulmonary TB + 978(68.9) 442(31.1) 1 1 1 Clinically diagnosed TB 450(60.9) 289(39.1) 0.89(0.83-0.95) 0.93(0.88-1.00) 0.040 0.80(0.65-0.98) 0.027 Extra pulmonary TB 944(48.7) 996(51.3) 0.71(0.67-0.75) < 0.001 0.76(0.69-0.84) < 0.001 0.50(0.39-0.62) < 0.001 Not documented 5(71.4) 2(28.6) 1.04(0.65-1.66) 0.878 1.12(0.96-1.30) 0.150 1.29(0.81-2.04) 0.284 HIV status < 0.001 < 0.001 < 0.001 < 0.001 Positive 375(65.6) 324(34.4) 1 1 1 Negative 1448(53.6) 760(46.4) 1.22(1.13-1.31) < 0.001 1.22(1.12-1.33) < 0.001 1.67(1.36-2.04) < 0.001 Not documented 554(46.2) 645(53.8) 0.85(0.78-0.93) 0.001 0.91(0.80-1.04) 0.154 0.85(0.65-1.10) 0.221 Chest x-ray finding < 0.001 0.001 0.528 0.456 Suggestive 1979(59.5) 1345(42.9) 1 1 1 Not suggestive 173(49.7) 175(50.3) 0.84(0.76-0.94) 0.002 0.97(0.80-1.18) 0.759 0.93(0.63-1.38) 0.708 Unknown/Atypical 4(57.1) 3(42.9) 0.96(0.51-1.83) 0.904 1.04(0.56-1.93) 0.899 1.12(0.24-5.16) 0.881 Not documented 221(51.8) 206(48.2) 0.88(0.80-0.97) 0.007 0.91(0.80-1.03) 0.138 0.79(0.59-1.05) 0.108 %, Row percentage; CI, confidence interval; PR, prevalence ratio; TB, tuberculosis. v b t i t p d r t K u t o l b s a a a p o a t a w p c E c a s H T T d p i r r t d p o h C c t o c D F c E t ersed some gains in TB treatment indicators [1] . Decline in TSR has een attributed to co-infection with HIV, increase in age, in addition o possibility of multidrug resistant TB and the potential for drug-drug nteractions in situations of HIV co-infection [21] . Commensurate with he decline in TSR was an increase in the number of deaths within the eriod 2019-2021; so was the trend globally during the COVID- 19 pan- emic [1] . Although it is desirable for cure rates to be higher than completed ates (90% and 85% consecutively by, our cure rates were lower than he completed rates [22] . This could be due to the testing capacity of the orle-Bu Teaching Hospital being low due to logistics being relatively navailable or the skills of the laboratory staff being low. Therefore, here is a failure to confirm bacteriological cure for completed treatment utcomes. Our study found that patients aged between 35-64 and 65 + were ess likely to have successful treatment outcomes as compared to those etween the ages of 18-34 years. This was similar to other studies. In a tudy done among patients in a refugee camp in Ethiopia, patients aged bove 45 years were likely to have unsuccessful outcomes [19] . This was ttributed to the high tendency of poor compliance to drugs. Similarly in study done in the greater Accra Regional Hospital it was observed that atients above 64 years were more likely to have unsuccessful treatment utcomes [20] . This was associated with the poor immune system from ging. Patients who were clinically diagnosed (smear negative PTB-) and hose with EPTB were also less likely to experience successful outcomes s compared to patients diagnosed of PTB + . This finding is congruent ith that found by during a research in Ghana [13] . In their study PTB + atients were 0.66 times less likely to have unsuccessful outcomes as ompared to patients who were clinically diagnosed and those with PTB. Similarly other studies discovered that the risk of adverse out- omes increased among smear negative and EPTB patients, principally ttributed to delays in diagnosis [23] . It was found that HIV negative patients had increased odds of uccessful treatment outcomes as compared to TB patients who were 13 IV positive. This is line with several other studies’ findings [24,25] . hese studies reported increased odds of unsuccessful outcomes among B/HIV coinfection patients. Factors for the poor outcomes are drug- rug interaction, increased comorbidities, and lack of cotrimoxazole rophylaxis therapy [13] . Our study was not without limitations. Firstly, the study lacked the nclusion of some significant factors like education status, family size, esidence, family support and medication side effects which have been eported to be associated with TB treatment outcomes [26] . The limita- ion experienced was mainly due to poor data completeness. However, ata quality standards were ensured by training data collectors and su- ervisors. Secondly the study encountered limitations with missing data n some variables like weight, HIV testing, ART initiation and drug ad- erence. These variables could not be analyzed. onclusion The study reported decline in TB case notifications with a signifi- ant drop in TSR over the 10-year period with the country being unable o meet the TB targets and milestones especially in area of treatment utcomes. The decline in TSR also occurred at the same time of the oc- urrence of the COVID-19 pandemic. eclarations of Competing Interest The authors have no competing interests to declare unding This research did not receive any specific grant from funding agen- ies in the public, commercial, or not-for-profit sectors. thical approval This study was approved by the Institutional Review Board of he Korle-Bu Teaching Hospital with approval number KBTH-STC-IRB P. Puplampu, I. Kyeremateng, O. Asafu-Adjaye et al. IJID Regions 10 (2024) 9–14 0 t b A s O m m r D R [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ 0050/2023. A full waiver of informed consent was granted since pa- ients were not encountered directly in the study and data was obtained y data extraction uthor contributions PP, IK, OAA, AAA and VJG were involved in study conception and tudy design. OO and VJG were involved in data collection. PP, VJG, AA, AAA, KA and IK were involved in data review and analysis, anuscript writing and review. RS, PP, KA and VJG were involved in anuscript writing, review, and finalization of manuscript. All authors ead and approved the final manuscript. ata availability Data will be made available upon request. eferences [1] World Health Organization. WHO world TB report 2021 . [2] Izudi J, Semakula D, Sennono R, Tamwesigire IK, Bajunirwe F. Treatment suc- cess rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis. 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Glob Health Action 2014; 7 :25382. doi: 10.3402/gha.v7.25382 . http://refhub.elsevier.com/S2772-7076(23)00112-1/sbref0001 https://doi.org/10.1136/BMJOPEN-2019-029400 https://doi.org/10.2147/IJGM.S135305 https://doi.org/10.1186/s12879-019-4392-6 https://doi.org/10.1186/s12889-021-12056-1 https://doi.org/10.5588/IJTLD.15.0123 https://doi.org/10.1016/j.amsu.2020.11.032 https://doi.org/10.1136/bmjopen-2021-056496 https://doi.org/10.20471/ACC.2019.58.04.04 https://www.stoptb.org/static_pages/GHA_Dashboard.html https://vizhub.healthdata.org/gbd-compare/ https://doi.org/10.5588/IJTLD.19.0163 https://doi.org/10.1371/journal.pone.0234878 https://doi.org/10.1186/s13104-016-2136-x https://doi.org/10.4236/JTR.2013.13006 https://www.who.int/publications/i/item/9789241505345 http://refhub.elsevier.com/S2772-7076(23)00112-1/sbref0017 https://doi.org/10.1016/j.ijid.2022.03.046 https://doi.org/10.1186/s12879-021-05828-y https://doi.org/10.1155/2021/9952806 https://doi.org/10.1155/2020/1097581 http://doi.org/10.1136/bmj.2.5422.1454 https://doi.org/10.1016/S1995-7645(14)60172-3 https://doi.org/10.1186/s12879-017-2598-z https://doi.org/10.5588/ijtld.13.0238 https://doi.org/10.3402/gha.v7.25382 Evaluation of treatment outcomes among adult patients diagnosed with tuberculosis in Ghana: A 10 year retrospective review Introduction Methods Study design and settings Study participants Data source and extraction Outcome measures and definitions Data handling and analysis Results Overall trend in treatment success rates Trend in tuberculosis treatment success rates by HIV status Tuberculosis treatment outcomes by sociodemographic and clinical characteristics Factors associated with treatment outcomes Discussion Conclusion Declarations of Competing Interest Funding Ethical approval Author contributions Data availability References