Abstract
BackgroundWhile several studies have assessed the associations between biological factors and tuberculosis (TB) transmission, our understanding of the associations between TB transmission and social and economic factors remains incomplete. We aimed to explore associations between community TB transmission and socio-economic factors within a high TB-HIV burdened setting.MethodsWe conducted a cross-sectional molecular epidemiology study among adult patients attending a routine TB clinic. Demographic and clinical data were extracted from TB registers and clinical folders; social and economic data were collected using interviewer-administered questionnaires; Mycobacterium tuberculosis isolates were genotyped and classified as clustered/non-clustered using IS6110-based Restriction Fragment Length Polymorphism. Composite “social” and “economic” scores were generated from social and economic data. Data were analyzed using StataCorp version 15.0 software. Stratified, bivariable analyses were performed using chi-squared. Wilcoxon signed rank tests; univariable and multivariable logistic regression models were developed to explore associations in the social, economic, traditional and composite TB risk factors with TB transmission.ResultsOf the 505 patient Mtb strains, 348(69%) cases were classified as clustered and 157(31%) were non-clustered. Clustered cases were more likely to have lived longer in the study community, (odds ratio [OR] = 1.05, 95% Confidence interval [C.I]:1.02–1.09, p = 0.006); in the same house (OR = 1.04, C.I: 0.99–1.08, p = 0.06); and had increased household crowding conditions (i.e fewer rooms used for sleeping, OR = 0.45, C.I:0.21–0.95, p = 0.04). Although a higher proportion of clustered cases had a low economic score, no statistically significant association was found between clustering and either the economic score (p = 0.13) or social score (p = 0.26).ConclusionsWe report a novel association between Mtb transmission and prolonged stay within a high burdened community. Transmission was also associated with fewer rooms for sleeping in a household. Increased social interaction and prolonged residence in a high burdened community are important factors linked to Mtb transmission, possibly due to increased probability of higher effective contact rates. The possible importance of degrees of poverty within low socio-economic setting warrants further study.
Highlights
While several studies have assessed the associations between biological factors and tuberculosis (TB) transmission, our understanding of the associations between TB transmission and social and economic factors remains incomplete
Traditional TB molecular epidemiology studies have sought to distinguish between disease due to recent Mycobacterium tuberculosis (Mtb) infection or transmission compared to reactivation of latent infection [5,6,7]
We aimed to investigate how social, economic and composite factors related to community TB transmission in a high TB and Human immuno-virus (HIV) burdened community setting
Summary
While several studies have assessed the associations between biological factors and tuberculosis (TB) transmission, our understanding of the associations between TB transmission and social and economic factors remains incomplete. We aimed to explore associations between community TB transmission and socio-economic factors within a high TB-HIV burdened setting. Studies from various settings have reported varying findings on risk factors for clustering such as age, immigrant status, HIV infection homelessness, alcoholism, intravenous drug use, social mixing and treatment failure [11,12,13,14,15]. There remains a need to further explore and understand the factors driving Mtb transmission in poor socio-economic communities with a high burden of both TB and HIV. The identification of such risk factors could inform targeted control measures and interventions aimed at interrupting TB disease transmission chains and reducing TB incidence, in line with the WHO’s End TB Strategy [19]. We aimed to investigate how social, economic and composite factors related to community TB transmission (clustering vs. non-clustering) in a high TB and HIV burdened community setting
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