Persistent sputum smear positivity among new cases of pulmonary tuberculosis after 2 months of self-administered outpatient treatment in Yaounde, Cameroon

Abstract

Objectives: The objective of this study was to determine the incidence of persistent sputum smear positivity (PSSP) and identify factors associated with it in new sputum smear-positive pulmonary tuberculosis (SSPPTB) patients after 2 months of self-administered outpatient treatment. Materials and Methods: This was a retrospective review of the records of a cohort of all consecutive new cases of SSPPTB followed up at the tuberculosis diagnostic and treatment center of the Jamot Hospital in Yaounde between January 2015 and December 2021. Multivariable logistic regression was used to relate baseline characteristics with PSSP at the end of the 2-month self-administered outpatient treatment. Results: A total of 3136 new cases of SSPPTB with a mean age of 35.88 ± 13.42 years, including 1866 (59.50%) males, were studied. Persistent positive sputum smears after 2 months of treatment were observed in 332 patients, giving a cumulative incidence of 10.59% (95% confidence interval [CI]: 9.51–11.66). Multiple logistic regression analysis showed that age ≥35 years (odds ratio [OR]: 1.51; 95% CI: 1.19–1.90; P = 0.001), male gender (OR: 1.38; 95% CI: 1.08–1.76; P = 0.010), and pre-treatment bacillary load in sputum smear ≥2+ (OR: 2.44; 95% CI: 1.81– 3.30; P = 0.001) were significantly and independently associated with PSSP. Conclusion: The rate of PSSP in new SSPPTB patients after 2 months of self-administered outpatient treatment is similar to rates observed before 2015. Direct observed therapy targeted at patients with factors associated with PSSP should be considered to improve outcomes.