Diagnosis and treatment outcomes of adult tuberculosis in an urban setting with high human immunodeficiency virus prevalence in Sierra Leone: A retrospective cohort study.

OBJECTIVE: To assess the diagnosis, treatment outcomes and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. METHODS: A retrospective cohort study was conducted of adult TB patients aged >/= 15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. RESULTS: Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n=1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%) and had pulmonary TB (96.3%). Treatment outcomes were as follows: cured (29.0%), completed (29.0%), treatment failure (0.5%), lost to follow up (24.3%), transferred/not evaluated(12.9%) and died (4.5%). The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older [AOR, 3.48; (1.15-10.56) p=0.027] and HIV positive status [AOR, 3.50; (1.72-7.12); p=0.001] were independent predictors of mortality. CONCLUSION: Sub-optimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets.