Trends in tuberculosis notification and mortality and factors associated with treatment outcomes in Serbia, 2005 to 2015

Abstract

Background Previously a country with medium tuberculosis (TB) burden, Serbia almost reached a low TB burden during the period 2005 to 2015. Aim The aim of this study was to analyse the trends in notification rates and treatment success rates as well as to identify predictors of treatment outcomes. Methods We performed a trend analysis and logistic regression analysis of 17,441 TB cases registered from 2005 to 2015 in all health facilities in Serbia, to identify predictors of treatment success, loss to follow-up and mortality. Results From 2005 to 2015, TB notification rate and mortality in Serbia decreased but treatment success remained below the global target. Loss to follow-up was associated with retreatment (odds ratio (OR) = 2.38; 95% confidence interval (CI): 2.08–2.77), male sex (OR = 1.57; 95% CI: 1.39–1.79), age younger than 65 years (OR = 1.37; 95% CI: 1.20–1.51), lower education level (OR = 2.57; 95% CI: 1.74–3.80) and pulmonary TB (OR = 1.28; 95% CI: 1.06–1.56). Deaths were more frequent in retreatment cases (OR = 1.39; 95% CI: 1.12–1.61), male patients (OR = 1.34; 95% CI: 1.19–1.52), those 65 years and older (OR = 4.34; 95% CI: 4.00–5.00), those with lower education level (OR = 1.63; 95% CI: 1.14–2.33) and pulmonary TB (OR = 2.24; 95% CI: 1.78–2.83). Conclusions Special interventions should be implemented to address groups at risk of poor treatment outcome.