Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study
Central African Journal of Public Health
Volume 6, Issue 1, February 2020, Pages: 23-32
Received: Dec. 20, 2019; Accepted: Jan. 4, 2020; Published: Jan. 13, 2020
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Authors
Boubacar Djelo Diallo, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Alhassane Diallo, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Lansana Mady Camar, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Gladys Djuiga Fotso, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Souleymane Camara, National Tuberculosis Control Program, Conakry, Guinea
Boubacar Bah, Carrière Tuberculosis Center, Conakry, Guinea
Magassouba Aboubacar Sidiki, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Alpha Oumar Barry, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Thierno Hassane Diallo, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Camara Aboubacar, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Néné Mamata Bah, National Reference Laboratory for Mycobacteria, Conakry, Guinea
Fulgence N’Zabintawali, National Reference Laboratory for Mycobacteria, Conakry, Guinea
Souleymane Hassane Haroune, Action Damien, Conakry, Guinea
Oumou Younoussa Sow, Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
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Abstract
Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.
Keywords
Conversion, Multidrug-resistant, Tuberculosis, Guinea
To cite this article
Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camar, Gladys Djuiga Fotso, Souleymane Camara, Boubacar Bah, Magassouba Aboubacar Sidiki, Alpha Oumar Barry, Thierno Hassane Diallo, Camara Aboubacar, Néné Mamata Bah, Fulgence N’Zabintawali, Souleymane Hassane Haroune, Oumou Younoussa Sow, Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study, Central African Journal of Public Health. Vol. 6, No. 1, 2020, pp. 23-32. doi: 10.11648/j.cajph.20200601.15
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Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under 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 work is properly cited.
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