Variation in tuberculosis treatment outcomes and treatment supervision practices in Uganda

• Published in: Journal of clinical tuberculosis and other mycobacterial diseases 2020-12, Vol.21, p.100184-100184, Article 100184
• Main Authors: Berger, Christopher A., Kityamuwesi, Alex, Crowder, Rebecca, Lamunu, Maureen, Kunihira Tinka, Lynn, Ggita, Joseph, Sanyu Nakate, Agnes, Namale, Catherine, Oyuku, Denis, Chen, Katherine, Turyahabwe, Stavia, Cattamanchi, Adithya, Katamba, Achilles
• Format: Article
• Language: English
• Subjects: Practice variation; Quality of care; Tuberculosis
• ISSN: 2405-5794; 2405-5794
• DOI: 10.1016/j.jctube.2020.100184

Variation in healthcare delivery is increasingly recognized as an important metric of healthcare quality. Directly observed therapy (DOT) has been the standard of care for tuberculosis (TB) treatment supervision for decades based on World Health Organization (WHO) guidelines. However, variation in implementation of DOT and associated TB treatment supervision practices remains poorly defined. We collected individual patient data from TB treatment registers at 18 TB treatment units in Uganda including District Health Centers, District Hospitals, and Regional Referral Hospitals. We also administered a survey and did observations of TB treatment supervision practices by health workers at each site. We describe variation in TB treatment outcomes and TB treatment supervision practices. Of 2767 patients treated for TB across the 18 clinical sites between January 1 and December 31, 2017, 1740 (62.9%) were men, most were of working age (median 35 years, interquartile range [IQR] 27 – 46), 2546 (92.0%) had a new TB diagnosis, and nearly half (45.9%, n = 1283) were HIV positive. The pooled treatment success proportion was 69.4% (95% confidence interval [CI] 67.8 – 71.1) but there was substantial variation across sites (range 42.6 – 87.6%, I-squared 92.7%, p