Factors associated with the therapeutic outcomes of tuberculous patients in the city of Antananarivo

<b>Context</b>: Unfavourable therapeutic outcomes are frequent situations that condition the effectiveness of tuberculosis (TB) control in Madagascar. Treatment failure and abandonment exposes to clinical complications and death. They perpetuate the spread of the disease and the development of drug resistance. <b>Objective</b>: The objective of this study is to determine factors associated with the therapeutic outcomes of TB. <b>Methods</b>: A retrospective cohort study of TB patients diagnosed and treated from January 1 to December 31, 2018, was conducted at the TB Diagnostic and Treatment Center of Analakely Hospital (CHUSSPA). Univariate and multivariate logistic regression was used to establish the relationship between dependent and independent variables. <b>Results</b>: The study enrolled 628 patients with a mean age of 37.19 with a standard deviation of 15.86 years. The sex ratio of males to females was estimated to be 1.57. The treatment success rate is estimated at 82.3% and the death rate at 4.9%. The failure and drop-out rates are estimated at 0.2 per cent and 8.3 per cent respectively. The determinant of success was represented by female gender (AOR 1.67 [1.07-2.66]; p=0.026). The smear negative pulmonary TB (SMEAR-) is an unfavourable factor for treatment success (AOR 0.38 [0.23-0.65]; p&lt;0.001). The discontinuation factor was represented by the SNPTB clinical form (AOR 3.17 [1.60-6.21]; p=0.001). The SNPTB clinical form (AOR=8.03 [3.01-23.72]; p&lt;0.001]) and the extra-pulmonary form (EPTB) with an AOR 5.15 [1.99-14.95]; p=0.001 are found as a factor in the occurrence of deaths. <b>Conclusion</b>: Reinforcement of the diagnostic strategy for MPT patients - and of the therapeutic education of male and MPT patients - and rigorous monitoring of EPTB forms are essential to reduce the occurrence of these unfavourable outcomes.

**背景**：不良治疗结局是影响马达加斯加结核病（TB）防控成效的常见情形。治疗失败与治疗中断不仅会使患者面临临床并发症与死亡风险，还会加剧疾病传播并催生耐药结核的发生发展。
**目的**：本研究旨在探讨与结核病治疗结局相关的影响因素。
**方法**：本研究于2018年1月1日至12月31日期间，在阿纳拉克莱医院（CHUSSPA）结核病诊疗中心开展，纳入同期确诊并接受治疗的结核病患者，采用回顾性队列研究设计。通过单因素及多因素Logistic回归分析，明确因变量与自变量之间的关联关系。
**结果**：本研究共纳入628例患者，平均年龄为37.19岁，标准差为15.86岁。男女性别比为1.57。治疗总成功率为82.3%，病死率为4.9%，治疗失败率与脱落率分别为0.2%与8.3%。女性性别为治疗成功的保护因素（调整后比值比[AOR]=1.67，95%置信区间[1.07-2.66]；p=0.026）。痰涂片阴性肺结核（SMEAR-）是治疗成功的不利因素（AOR=0.38，95%置信区间[0.23-0.65]；p<0.001）。痰涂片阴性肺结核（SNPTB）临床表型是治疗脱落的危险因素（AOR=3.17，95%置信区间[1.60-6.21]；p=0.001）。痰涂片阴性肺结核（SNPTB）临床表型（AOR=8.03，95%置信区间[3.01-23.72]；p<0.001）与肺外结核（EPTB）（AOR=5.15，95%置信区间[1.99-14.95]；p=0.001）均为患者死亡的危险因素。
**结论**：强化MPT患者的诊断策略、男性及MPT患者的治疗教育，并对肺外结核（EPTB）表型实施严格监测，对于降低此类不良治疗结局的发生至关重要。