Abstract
Background Historically, tuberculosis (TB) has been responsible for significant disease burden among the military both during peace and conflict. A routine review of Zimbabwe Defence Force (ZDF) data showed 36% of reported deaths could be attributed to TB. We conducted a study to determine the TB trends and outcomes among patients managed in ZDF health facilities between 2010-2015.
Methods Retrospective cohort study of TB patients (military and dependents). Data were extracted from ZDF TB registers and analyzed for trends in notification and outcomes. Independent factors associated with unfavourable TB treatment outcomes were modeled using multivariable regression.
Results Of the total 1298 TB patients, 84% were males, median age 37 years and 92% from Army facilities. Ninety three percentage had pulmonary TB, 87% were new patients and 68% HIV co-infected (97% on antiretroviral therapy[ART]). Number of TB cases reduced two-fold between 2010-2015 (317 vs 115). Treatment outcomes remained relatively stable with overall treatment success of 81%, 9.9% deaths, 0.2% loss to follow up, 2.2% treatment failure, 6.6% not evaluated. Clients who were HIV-positive and not on ART were 3.81 times likely to have unfavourable outcome.
Conclusion This is the first study of TB in an African defence force showed decreasing trends in notified TB cases. Though treatment success was comparable over time, it still fell below international targets. Being HIV-positive (even with ART) was associated with increased unfavourable outcomes. Continued monitoring, evaluation and increased support of the TB programme within this high risk population is recommended.