Prospective study of predictors of treatment failure among drug-sensitive TB patients in Armenia

Background

In 2024, tuberculosis (TB) caused the highest number of deaths from a single infection globally. Despite the decline in TB incidence rates over the past decade, treatment failure rates still remain substantial in Armenia. Studies exploring factors related to TB treatment failure are scarce. This study prospectively assessed predictors of treatment failure among primary drug-sensitive TB patients in Armenia.

Methods

The study included baseline and follow-up interviews conducted with all adult patients diagnosed with primary drug-sensitive TB in Armenia between April 2019 and February 2021, who consented to participate. Each patient was interviewed twice – at the start of TB treatment course and shortly after completing it. The questionnaires collected information on patient’s TB-related knowledge, stigma, social support, health, depression, and socio-demographics. Data on patients’ treatment outcomes were obtained from their TB care providers. Logistic regression model was fitted to identify predictors of treatment failure.

Results

A total of 401 patients participated in baseline interviews and 285 (71.1%) were tracked at the follow-up. The mean age of the baseline sample was 46.0 years (SD 15.3) and 75.3% were male. Treatment failure rate was 14.3% (n = 57, of which 23 regimen violations, 19 deaths, and 15 failures). Independent predictors of treatment failure included older age (aOR 1.03, p = 0.008), planning migrant work (aOR 2.45, p = 0.009), incomplete secondary education (aOR 2.1, p = 0.011), and depression at the baseline (aOR 1.78, p < 0.043), while being married was protective (aOR 0.49, p = 0.017).

Conclusions

Identified modifiable predictors of treatment failure indicate the importance of timely psychological counselling and financial support to TB patients, with special attention to those with lower education and planning migrant work. Compliance to these recommendations can significantly improve treatment outcomes among drug-sensitive TB patients.

Key messages

• TB treatment failure is still common in Armenia. Older age, depressive symptoms, lower education and planning migrant work are predictive for TB treatment failure, and being married is protective.

• Early psychological counselling and education of TB patents combined with creating economic opportunities for them can substantially improve treatment outcomes among drug-sensitive TB patients.