Treatment outcomes among tuberculosis patients with co-morbidities at Ghana’s premier national referral centre: a retrospective cross-sectional study

Abstract

In Ghana, tuberculosis (TB) cases reached 19,000 in 2023 (15% above 2022). Co-morbidities such as human immunodeficient virus (HIV), diabetes, substance abuse, and hypertension can complicate treatment. The study evaluated co-morbidity prevalence among TB patients at a major Ghanaian hospital and their impact on treatment outcomes (treatment success, default, death). A retrospective descriptive cross-sectional study at the Chest Clinic, Korle-Bu Teaching Hospital, Accra, reviewed 2021–2022 records of 993 TB patients of which 258 had ≥ 1 co-morbidity. Demographics, co-morbidities (HIV, diabetes, substance abuse, hypertension), and outcomes (cure, default, death) were recorded. Associations between co-morbidities and outcomes were analysed using chi-square tests and logistic regression. Of the 993 TB patients, 258/993 (26.0%) had TB with comorbidity and 149/258 (57.8%) were treated successfully. The 258 comorbid TB patients (mean age 44 ± 15 years) were 60.5% male and 53.9% married with co-morbidities: HIV 72.9%, hypertension 5.8%, substance abuse 5.8% and diabetes 4.3%. The TB/HIV patients had 28.2% mortality and substance abusers had 33.3% mortality. Higher odds of death were seen in TB/HIV (OR ≈ 1.90, 95% CI 0.94–3.81, p = 0.08) and substance abuse (OR ≈ 1.53, p = 0.54). TB/diabetes showed a non-significant survival benefit (0% vs. ~ 26% in others, p = 0.07). Default was 12.8% overall and it was higher in substance abusers (26.7% vs. 13.2%, OR ≈ 2.68, 95% CI 0.82–8.8, p = 0.11). Younger age and single status strongly predicted default: <35 vs. ≥ 35 years (36.0% vs. 3.3%, OR = 16.6, 95% CI 6.4–43.4, p < 0.001); single vs. partnered (30.1% vs. 5.9%, OR = 6.8, 95% CI 2.9–15.9, p < 0.001). However, findings may not be generalizable to rural or primary care settings, which is acknowledged as a study limitation. TB patients with co-morbid conditions experienced poorer treatment outcomes than patients without such co-morbidities. These findings underscore the need for integrated care strategies that address both TB and co-existing chronic diseases. Strengthening the management of co-morbid illnesses alongside TB treatment may improve patient outcomes and boost overall treatment success rates. Not applicable.