Tuberculosis treatment outcomes among disadvantaged patients in India

Setting: Urban slums and poor rural areas, India, 2012-2014. Objective: To describe characteristics of tuberculosis (TB) patients enrolled in treatment through Operation ASHA, a non-governmental organisation serving disadvantaged populations in India, and to identify risk factors for unfavourable treatment outcomes. Design: Retrospective cohort study. Patient characteristics were assessed for their relationship with treatment outcomes using mixed effects logistic regression adjusting for clustering by treatment centre and Indian state. Outcomes were considered favourable (cured/treatment completed) or unfavourable (treatment failure, loss to follow-up, death, switch to multi-drug resistant TB treatment, transfer out). Results: 7148/8415 (84.9%) patients had a favourable outcome. On multivariable analysis, unfavourable outcomes were more common amongst men (odds ratio [OR]=1.31, 95% confidence interval [CI] 1.15-1.51), older patients (OR=1.12 [1.04-1.21]) and previously treated patients (OR=2.05 [1.79-2.36]). Compared to pulmonary smear-negative patients, those with extra-pulmonary disease were less likely (OR=0.72 [0.60-0.87]) whilst smear-positive pulmonary patients were more likely to have unfavourable outcomes (OR=1.38 [1.15-1.66] for low [scanty/1+] and OR=1.71 [1.44-2.04] high [2+/3+] positive smears, respectively). Conclusion: The treatment success rate within Operation ASHA is comparable to that reported nationally for India. Men, older patients, retreatment cases and smear-positive pulmonary TB patients may need additional interventions to ensure a favourable outcome.