Gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis in Kenya

SUMMARY OBJECTIVE:To determine gender differences in treatment outcomes among 15‐49 year olds with smearpositive pulmonary tuberculosis (PTB) and factors associated with poor outcomes in Kenya. DESIGN:Retrospective descriptive cohort. RESULTS:Of 16056 subjects analysed, 38% were female and 62% male. Females had a higher risk of poor treatment outcome than males (12% vs. 10%,P, 0.001; adjusted OR 1.29, 95%CI 1.16‐1.44,P, 0.001). In the first multivariate model, restricting the analysis to human immunodeficiency virus (HIV) positive patients and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor outcome (OR 0.99, 95%CI 0.86‐1.13,P¼0.844). In the model restricted to HIV-negative patients, a nonsignificantly lower risk was found (OR 0.89, 95%CI 0.73‐1.09,P¼0.267). In the second model, restricting analysis to patients on antiretroviral therapy (ART) and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor PTB treatment outcomes (OR 0.98, 95%CI 0.84‐1.14,P¼0.792). In the model restricted to HIV-positive patients not on ART, a non-significantly higher risk was found (OR 1.15, 95%CI 0.79‐1.67,P¼0.461). CONCLUSION:Females of reproductive age are likely to have poorer treatment outcomes than males. Among females, not commencing ART during anti-tuberculosis treatment seemed to be associated with poor outcomes. KEY W O RDS: HIV; women; reproductive age