Abstract
BackgroundPoverty is associated with increased risk of active tuberculosis (TB) disease onset, but the relation between household income and TB treatment outcomes is not well understood. The objective of this study was to determine household income characteristics associated with poor TB treatment outcome among newly diagnosed patients with pulmonary TB in the country of Georgia.MethodsA prospective cohort study was conducted among newly diagnosed smear positive pulmonary TB patients. Clinical and household data were collected from all consecutive patients seeking care at TB facilities in two major cities and one rural region in Georgia. Patients were followed prospectively during anti-TB regimens to determine treatment outcome. Bivariate analyses were used to determine the association of individual patient and household level characteristics with poor TB treatment outcome. A multivariable logistic model was used to estimate the adjusted association between patient household characteristics and poor TB treatment outcome.ResultsAfter six months TB therapy, treatment outcome was available for 193 of 202 enrolled patients, of these 155 (80.3%) had a favorable TB treatment outcome. Compared to TB patients with poor treatment outcome, those with favorable treatment outcomes were younger (median 33.0 vs. 42.5 years), reported higher household monthly income (median $137 USD vs. $85 USD), were less likely to be unemployed (38.7 vs. 47.4%), and had higher level of education (38.7% vs. 31.6% with college education or greater). In multivariable analysis adjusted for age, sex, and socio-economic indicators, only low household income was remained statistically significantly associated with poor TB treatment outcome. Compared with patients from households with the highest tertile of monthly income, those in the middle tertile (aOR 4.28 95% CI 1.36, 13.53) and those in the lowest category of income (aOR 6.18 95% CI 1.83, 20.94) were significantly more likely to have poor treatment outcomes.ConclusionWe demonstrated that TB patients in Georgia with lower household income were at greater risk of poor TB treatment outcomes. Providing targeted social assistance to TB patients and their households may improve clinical response to anti-TB therapy.
Highlights
Poverty is associated with increased risk of active tuberculosis (TB) disease onset, but the relation between household income and TB treatment outcomes is not well understood
Among 303 patients with newly diagnosed pulmonary TB registered in Tbilisi (180), Kutaisi (63), and Samegrelo (60), 66.7% (202 of 303) of the cases were enrolled in the study (100 in Tbilisi, 51 in Kutaisi, and 51 in Zugdidi), and 95.5% (193 of 202) had complete data that was included in the analysis
Results of multivariable analysis In multivariable analysis adjusted for sex, age, household income, proportionate monthly income spent on healthcare, and stigma, only low baseline household income remained statistically significantly associated with poor TB treatment outcome (Table 2)
Summary
Poverty is associated with increased risk of active tuberculosis (TB) disease onset, but the relation between household income and TB treatment outcomes is not well understood. The objective of this study was to determine household income characteristics associated with poor TB treatment outcome among newly diagnosed patients with pulmonary TB in the country of Georgia. The proportion of new smear positive cases achieving success remains low, in 2008 only 73% achieved this target, and in 2010 the proportion was 76% [1]. Treatment default remains one of the most important causes of poor TB treatment outcome for Georgian patients receiving anti TB therapy. In 2010, 7% of new TB patients with positive sputum smear or culture defaulted from TB treatment [1]. Default rate among MDR TB patients was reported as high as 21.9% [3]
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