Abstract
BackgroundTuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes.MethodsThis cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β6) and post-intervention trend (β7).ResultsShort-term, inter-province migrants experienced lower treatment success (aRR = 0.95 [95% CI: 0.92–0.99], p = 0.010) and higher loss to follow-up (aOR = 1.98 [95% CI: 1.44–2.72], p < 0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR = 1.86 [95% CI: 1.03–3.36], p = 0.041). There was evidence that patients > 55 years of age (aRR = 0.93 [95% CI: 0.89–0.96], p < 0.001), relapse patients (aRR = 0.89 [95% CI: 0.84–0.94], p < 0.001), and retreatment patients (aRR = 0.62 [95% CI: 0.52–0.75], p < 0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR = 0.77 [95% CI: 0.73–0.82], p < 0.001) and higher loss to follow-up (aOR = 2.18 [95% CI: 1.55–3.06], p < 0.001). The provision of treatment adherence support increased treatment success (IRR(β6) = 1.07 [95% CI: 1.00, 1.15], p = 0.041) and reduced loss to follow-up (IRR(β6) = 0.17 [95% CI: 0.04, 0.69], p = 0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β7) = 0.90 [95% CI: 0.83, 0.98], p = 0.019).ConclusionsEconomic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.
Highlights
Tuberculosis (TB) remains a major cause of avoidable deaths
The total sample included 10,515 drug-susceptible TB patients notified at the Go Vap and District 8 District TB Unit (DTU) (Table 2), of whom 52.3% (5502/10,515) were notified prior to the intervention
There was moderate evidence that intra-province migrants were more likely to be lost to follow-up than permanent residents
Summary
Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors These factors expose them to higher risks for TB incidence and poor treatment outcomes. Documented barriers to successful treatment completion include pill burden, adverse events and the need for daily attendance at treatment clinics to take DOTS [7,8,9]. Another major reason is that adherence to TB treatment protocols represents a heavy economic burden for TB patients in Viet Nam and many other settings due to lost income, travel and opportunity costs [10, 11]. 77–92% of susceptible cases were successfully treated in 2017 [2]
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