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Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia
BACKGROUND: At least 13–20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurr...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938018/ https://www.ncbi.nlm.nih.gov/pubmed/31888518 http://dx.doi.org/10.1186/s12879-019-4709-5 |
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author | Mutembo, Simon Mutanga, Jane N. Musokotwane, Kebby Kanene, Cuthbert Dobbin, Kevin Yao, Xiaobai Li, Changwei Marconi, Vincent C. Whalen, Christopher C. |
author_facet | Mutembo, Simon Mutanga, Jane N. Musokotwane, Kebby Kanene, Cuthbert Dobbin, Kevin Yao, Xiaobai Li, Changwei Marconi, Vincent C. Whalen, Christopher C. |
author_sort | Mutembo, Simon |
collection | PubMed |
description | BACKGROUND: At least 13–20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurrent TB between different geographical settings. The objective of our study was to estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings. METHODS: In a retrospective cohort study conducted in southern province of Zambia, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Data was abstracted from the facility TB registers. RESULTS: Overall 3566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1). CONCLUSION: Recurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting where heightened TB control activities are focused on areas with poor treatment outcomes. |
format | Online Article Text |
id | pubmed-6938018 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-69380182019-12-31 Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia Mutembo, Simon Mutanga, Jane N. Musokotwane, Kebby Kanene, Cuthbert Dobbin, Kevin Yao, Xiaobai Li, Changwei Marconi, Vincent C. Whalen, Christopher C. BMC Infect Dis Research Article BACKGROUND: At least 13–20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurrent TB between different geographical settings. The objective of our study was to estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings. METHODS: In a retrospective cohort study conducted in southern province of Zambia, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Data was abstracted from the facility TB registers. RESULTS: Overall 3566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1). CONCLUSION: Recurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting where heightened TB control activities are focused on areas with poor treatment outcomes. BioMed Central 2019-12-30 /pmc/articles/PMC6938018/ /pubmed/31888518 http://dx.doi.org/10.1186/s12879-019-4709-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Mutembo, Simon Mutanga, Jane N. Musokotwane, Kebby Kanene, Cuthbert Dobbin, Kevin Yao, Xiaobai Li, Changwei Marconi, Vincent C. Whalen, Christopher C. Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia |
title | Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia |
title_full | Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia |
title_fullStr | Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia |
title_full_unstemmed | Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia |
title_short | Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia |
title_sort | urban-rural disparities in treatment outcomes among recurrent tb cases in southern province, zambia |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938018/ https://www.ncbi.nlm.nih.gov/pubmed/31888518 http://dx.doi.org/10.1186/s12879-019-4709-5 |
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