Recurrent pulmonary tuberculosis (PTB) remains a major challenge to tuberculosis control programme as it is associated with lower cure rate compared to new case. This study aimed to estimate the incidence rate, rural urban variation and associated factors of recurrent PTB at several selected BRAC implementing areas under National Tuberculosis Control Programme in Bangladesh.
A cohort of sputum smear positive pulmonary tuberculosis patients (n=987) who were declared as cured or treatment completed during July-September 2013 was selected. During October 2014 to November 2014 individuals were invited for an Xpert MTB/RIF assay and interview using a structured questionnaire. Respondents found positive in GeneXpert test were defined as recurrent PTB. We compared recurrent and non-recurrent cases to identify factors associated with recurrence. Potential confounding factors were entered in a stepwise logistic regression model to explore the independent risk factors and their strength of association.
Forty four patients were diagnosed as recurrent tuberculosis revealing a recurrence rate of 4.5%. Four (9.1%) of these 44 were found as rifampicin (n=1) or multi-drug (n=3) resistant. Higher incidence rate were noted in rural areas compared to urban areas (4.9% vs. 3.5%). Risk of developing recurrent tuberculosis was 4.4 times higher in patients having positive sputum smear at 2 months of treatment initiation (ODDS Ratio: 4.4; 95% CI: 1.9-10.2). Cured person who lived with a tuberculosis patients in same household had 2.8 times more risk of developing recurrent TB (OR: 2.8; 95% CI: 1.2-6.5).
Recurrent tuberculosis rate was found to be 4.5% in Bangladesh among patients who were treated and cured. Successfully treated patients are still at risk for recurrence if they have positive sputum smear at 2 month and exposure to household tuberculosis contact.