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Meta-Analysis
. 2023 Jul 19;18(7):e0286194.
doi: 10.1371/journal.pone.0286194. eCollection 2023.

Poor treatment outcome and associated risk factors among patients with isoniazid mono-resistant tuberculosis: A systematic review and meta-analysis

Ayinalem Alemu  1   2 , Zebenay Workneh Bitew  3 , Getu Diriba  1 , Getachew Seid  1   2 , Shewki Moga  1 , Saro Abdella  1 , Emebet Gashu  4 , Kirubel Eshetu  5 , Getachew Tollera  1 , Mesay Hailu Dangisso  1 , Balako Gumi  2
Affiliations
Meta-Analysis

Poor treatment outcome and associated risk factors among patients with isoniazid mono-resistant tuberculosis: A systematic review and meta-analysis

Ayinalem Alemu et al. PLoS One. .

Abstract

Background: To date, isoniazid mono-resistant tuberculosis (TB) is becoming an emerging global public health problem. It is associated with poor treatment outcome. Different studies have assessed the treatment outcome of isoniazid mono-resistant TB cases, however, the findings are inconsistent and there is limited global comprehensive report. Thus, this study aimed to assess the poor treatment outcome and its associated risk factors among patients with isoniazid mono-resistant TB.

Methods: Studies that reported the treatment outcomes and associated factors among isoniazid mono-resistant TB were searched from electronic databases and other sources. We used Joana Briggs Institute critical appraisal tool to assess the study's quality. We assessed publication bias through visual inspection of the funnel plot and confirmed by Egger's regression test. We used STATA version 17 for statistical analysis.

Results: Among 347 studies identified from the whole search, data were extracted from 25 studies reported from 47 countries. The pooled successful and poor treatment outcomes were 78% (95%CI; 74%-83%) and 22% (95%CI; 17%-26%), respectively. Specifically, complete, cure, treatment failure, mortality, loss to follow-up and relapse rates were 34%(95%CI; 17%-52%), 62% (95%CI; 50%-73%), 5% (95%CI; 3%-7%), 6% (95%CI; 4%-8%), 12% (95%CI; 8%-17%), and 1.7% (95%CI; 0.4%-3.1%), respectively. Higher prevalence of pooled poor treatment outcome was found in the South East Asian Region (estimate; 40%, 95%C; 34%-45%), and African Region (estimate; 33%, 95%CI; 24%-42%). Previous TB treatment (OR; 1.74, 95%CI; 1.15-2.33), having cancer (OR; 3.53, 95%CI; 1.43-5.62), and being initially smear positive (OR; 1.26, 95%CI; 1.08-1.43) were associated with poor treatment outcome. While those patients who took rifampicin in the continuation phase (OR; 0.22, 95%CI; 0.04-0.41), had extrapulmonary TB (OR; 0.70, 95%CI; 0.55-0.85), and took second-line injectable drugs (OR; 0.54, 95%CI; 0.33-0.75) had reduced risk of poor treatment outcome.

Conclusion: Isoniazid mono-resistant TB patients had high poor treatment outcome. Thus, determination of isoniazid resistance pattern for all bacteriologically confirmed TB cases is critical for successful treatment outcome. PROSPERO registration number: CRD42022372367.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart describing the selection of studies for the systematic review and meta-analysis of poor treatment outcome and its associated factors among patients with isoniazid mono-resistant tuberculosis.
Fig 2
Fig 2. Forest plot for the pooled successful treatment outcome rate among patients with isoniazid mono-resistant tuberculosis.
Fig 3
Fig 3. Funnel plot for the pooled successful treatment outcome rate among patients with isoniazid mono-resistant tuberculosis.
Fig 4
Fig 4. Forest plot for the pooled poor treatment outcome rate among patients with isoniazid mono-resistant tuberculosis.
Fig 5
Fig 5. Funnel plot for the pooled poor treatment outcome rate among patients with isoniazid mono-resistant tuberculosis.
Fig 6
Fig 6. Forest plot for the pooled relapse rate among successfully treated patients with isoniazid mono-resistant tuberculosis.
Fig 7
Fig 7. Forest plot for the association of previous TB treatment history with poor treatment outcome among isoniazid mono-resistant tuberculosis patients.
Fig 8
Fig 8. Forest plot for the association of being initially smear positive with poor treatment outcome among isoniazid mono-resistant tuberculosis patients.
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