Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

Abstract Setting Southern province, Zambia. Background At least 13 – 20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). Objective 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, 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). Results Overall 3,566 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.

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Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

10.21203/rs.2.11734/v3 ◽

2019 ◽

Author(s):

Simon Mutembo ◽

Jane Namangolwa Mutanga ◽

Kebby Musokotwane ◽

Cuthbert Kanene ◽

Kevin Dobbin ◽

...

Keyword(s):

Treatment Outcomes ◽

Rural Areas ◽

Directly Observed Therapy ◽

Public Health Importance ◽

Risk Of Death ◽

Therapy Strategy ◽

Rural And Urban ◽

Rural Settings ◽

Lost To Follow Up

Abstract 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 3,566 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 Anti-retroviral 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.

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Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

BMC Infectious Diseases ◽

10.1186/s12879-019-4709-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Simon Mutembo ◽

Jane N. Mutanga ◽

Kebby Musokotwane ◽

Cuthbert Kanene ◽

Kevin Dobbin ◽

...

Keyword(s):

Treatment Outcomes ◽

Rural Areas ◽

Directly Observed Therapy ◽

Public Health Importance ◽

Southern Province ◽

Risk Of Death ◽

Therapy Strategy ◽

Rural Settings ◽

Lost To Follow Up

Abstract 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.

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Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

10.21203/rs.2.11734/v1 ◽

2019 ◽

Author(s):

Simon Mutembo ◽

Jane Namangolwa Mutanga ◽

Kebby Musokotwane ◽

Cuthbert Kanene ◽

Kevin Dobbin ◽

...

Keyword(s):

Treatment Outcomes ◽

Rural Areas ◽

Directly Observed Therapy ◽

Risk Of Death ◽

Therapy Strategy ◽

Rural And Urban ◽

Risk Of Mortality ◽

Rural Settings ◽

Mdr Tb ◽

Urban Rural

Abstract Setting Southern province, Zambia. Background At least 13 – 20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). Objective 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, 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). Results Overall 3,566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% in urban and 11.3% in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow (LTFU), and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (aOR: 1.7; 95% CI: 1.2 2.7). Risk of LTFU was twice higher in rural than urban (aOR: 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 (aOR: 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 LTFU was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting.

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Factors associated with unfavourable treatment outcomes in people with HIV-associated tuberculosis in Armenia, 2015 to 2019

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1648 ◽

2021 ◽

Vol 91 (1) ◽

Author(s):

Lilit Gevorgyan ◽

Ruzanna Grigoryan ◽

Kostyantyn Dumchev ◽

Kristina Akopyan ◽

Anush Khachatryan ◽

...

Keyword(s):

Drug Resistance ◽

Treatment Outcomes ◽

Cox Regression ◽

Multivariable Analysis ◽

Unfavourable Outcome ◽

Factors Associated ◽

Risk Of Death ◽

Tb Treatment ◽

Lost To Follow Up

To evaluate factors associated with tuberculosis (TB) treatment outcomes in human Immunodeficiency Virus-Associated (HIV) TB patients in Armenia, we conducted a nation-wide cohort study using routine programmatic data of all HIV-associated TB patients receiving TB treatment with first- or second-line drugs from 2015 to 2019. Data were obtained from the TB and HIV electronic databases. We analysed occurrence of the combined unfavourable outcome (failure, lost to follow-up, death and not evaluated) and death separately, and factors associated with both outcomes using Cox regression. There were 320 HIV-associated TB patients who contributed a total of 351 episodes of TB treatment. An unfavourable TB treatment outcome was registered in 155 (44.2%) episodes, including 85 (24.2%) due to death, 38 (10.8%) lost to follow up, 13 (3.7%) failure and 19 (5.4%) not evaluated. Multivariable analysis showed that receipt of Antiretroviral Treatment (ART) [ART start before TB treatment: adjusted hazard ratio (aHR)=0.3, 95% confidence interval (CI): 0.2-0.5, aHR=, 95% CI:, 95% CI:, 95% CI:TB meningitis (aHR=4.4, 95% CI: 1.6-11.9) increased the risk. The risk of death was affected by the same factors as above in addition to the low BMI (aHR=2.5, 95% CI: 1.3-4.5) and drug resistance (aHR=2.3, 95% CI: 1.0-5.4). In the subsample of episodes receiving ART, history of interruption of ART during TB treatment increased the risk of unfavourable outcome (aHR=2.1 95% CI: 1.2-3.9), while ART start during TB treatment was associated with lower risk of both unfavourable outcome (within first 8 weeks: aHR: 0.5, 95% CI: 0.3-0.9; after 8 weeks: aHR: 0.4, 95% CI: 0.2-1.0) and death (within first 8 weeks: aHR: 0.2, 95% CI: 0.1-0.4; after 8 weeks: aHR: 0.1, 95% CI: 0.01-0.3). The rates of unfavourable TB treatment outcomes, and death in particular, among HIV-associated TB patients in Armenia are high. Our findings emphasize the protective effect of ART and the importance of proper management of cases complicated by drug resistance or meningitis.

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Status and Determinants of Treatment Outcomes Among New Tuberculosis Patients in South Korea: A Retrospective Cohort Study

Asia Pacific Journal of Public Health ◽

10.1177/10105395211000529 ◽

2021 ◽

pp. 101053952110005

Author(s):

Hyunjin Son ◽

Jeongha Mok ◽

Miyoung Lee ◽

Wonseo Park ◽

Seungjin Kim ◽

...

Keyword(s):

Cohort Study ◽

South Korea ◽

Success Rate ◽

Treatment Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Care Facilities ◽

Tuberculosis Patients ◽

Lost To Follow Up

This is a retrospective cohort study using notification data in South Korea. We evaluated the nationwide status, regional differences, and the determinants of treatment outcomes among tuberculosis patients. Treatment success rate improved from 77.0% in 2012 to 86.0% in 2015. The lost to follow-up rate was higher among older people, males, and foreign nationals. Health care facilities designated for the Public-Private Mix (PPM) project showed higher success rate and lower rate of lost to follow-up. Moreover, municipalities with low regional deprivation index had higher PPM project coverage. Since there is a large regional difference in the coverage of the PPM project, an additional community-based support program should be implemented, especially for tuberculosis patients residing in region with low PPM project coverage.

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Urban–rural disparity in cancer incidence in China, 2008–2012: a cross-sectional analysis of data from 36 cancer registers

BMJ Open ◽

10.1136/bmjopen-2020-042762 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042762

Author(s):

Shuai Yuan ◽

Shao-Hua Xie

Keyword(s):

Cancer Incidence ◽

Rural Areas ◽

Urban Areas ◽

Incidence Rates ◽

Cancer Type ◽

Anatomic Site ◽

Cross Sectional ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Urban Rural

ObjectiveThe substantial differences in socioeconomic and lifestyle exposures between urban and rural areas in China may lead to urban–rural disparity in cancer risk. This study aimed to assess the urban–rural disparity in cancer incidence in China.MethodsUsing data from 36 regional cancer registries in China in 2008–2012, we compared the age-standardised incidence rates of cancer by sex and anatomic site between rural and urban areas. We calculated the rate difference and rate ratio comparing rates in rural versus urban areas by sex and cancer type.ResultsThe incidence rate of all cancers in women was slightly lower in rural areas than in urban areas, but the total cancer rate in men was higher in rural areas than in urban areas. The incidence rates in women were higher in rural areas than in urban areas for cancers of the oesophagus, stomach, and liver and biliary passages, but lower for cancers of thyroid and breast. Men residing in rural areas had higher incidence rates for cancers of the oesophagus, stomach, and liver and biliary passages, but lower rates for prostate cancer, lip, oral cavity and pharynx cancer, and colorectal cancer.ConclusionsOur findings suggest substantial urban–rural disparity in cancer incidence in China, which varies across cancer types and the sexes. Cancer prevention strategies should be tailored for common cancers in rural and urban areas.

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Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities

BMJ Global Health ◽

10.1136/bmjgh-2018-001018 ◽

2018 ◽

Vol 3 (5) ◽

pp. e001018 ◽

Cited By ~ 51

Author(s):

Ramnath Subbaraman ◽

Laura de Mondesert ◽

Angella Musiimenta ◽

Madhukar Pai ◽

Kenneth H Mayer ◽

...

Keyword(s):

Treatment Outcomes ◽

Healthcare Providers ◽

Research Priorities ◽

Directly Observed Therapy ◽

Loss To Follow Up ◽

Individualised Care ◽

Health System Efficiency ◽

Tuberculosis Therapy

Poor medication adherence may increase rates of loss to follow-up, disease relapse and drug resistance for individuals with active tuberculosis (TB). While TB programmes have historically used directly observed therapy (DOT) to address adherence, concerns have been raised about the patient burden, ethical limitations, effectiveness in improving treatment outcomes and long-term feasibility of DOT for health systems. Digital adherence technologies (DATs)—which include feature phone–based and smartphone-based technologies, digital pillboxes and ingestible sensors—may facilitate more patient-centric approaches for monitoring adherence, though available data are limited. Depending on the specific technology, DATs may help to remind patients to take their medications, facilitate digital observation of pill-taking, compile dosing histories and triage patients based on their level of adherence, which can facilitate provision of individualised care by TB programmes to patients with varied levels of risk. Research is needed to understand whether DATs are acceptable to patients and healthcare providers, accurate for measuring adherence, effective in improving treatment outcomes and impactful in improving health system efficiency. In this article, we describe the landscape of DATs that are being used in research or clinical practice by TB programmes and highlight priorities for research.

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Smear Positive Tuberculosis Cases in Rajshahi District A Comparison Between Rural and Urban Areas

TAJ Journal of Teachers Association ◽

10.3329/taj.v17i2.3456 ◽

1970 ◽

Vol 17 (2) ◽

pp. 104-105

Author(s):

W Wasim Hussain ◽

M Azizul Haque ◽

Laila Shamima Sharmin ◽

ARM Saifuddin Ekram ◽

M Fazlur Rahman

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Detection Rate ◽

Case Finding ◽

Sputum Smear ◽

Case Detection Rate ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Rural Settings ◽

The City

This study was designed to know the case finding of sputum smear positive tuberculosis in Rajshahi district and also to see whether case finding was different in urban and rural settings. Our study reveals that case finding rate of smear positive tuberculosis cases in the city corporation area and rural areas of Rajshahi district are 52% and 28% respectively. Case detection rate of total Rajshahi district was 33%. Stronger efforts are needed to reach the national target of detecting 70% new smear positive TB cases by the end of 2005. doi: 10.3329/taj.v17i2.3456 TAJ 2004; 17(2): 104-105

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Abstract 13706: Differences in the Distribution of Systolic Blood Pressure by Rural and Urban Residence

Circulation ◽

10.1161/circ.142.suppl_3.13706 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Brittain Heindl ◽

George Howard ◽

Elizabeth A Jackson

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Racial Differences ◽

Rural Areas ◽

Urban Areas ◽

Census Bureau ◽

Urban Group ◽

Rural And Urban ◽

Urban Rural ◽

The Difference

Introduction: The incidence of stroke is higher in rural areas. Hypertension is the leading risk factor for stroke, but the difference in systolic blood pressure (SBP) for those living in rural and urban areas is unknown. Hypothesis: We hypothesized that rural residence is associated with higher SBP levels, and this difference is modified by race, sex, and United States (US) division. Methods: We analyzed 26,113 participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, recruited between 2003 and 2007. Participants were grouped based on the Rural-Urban Commuting Area (RUCA) scheme into urban, large-rural, and small-isolated rural groups. Resting SBP was measured during the initial home visit. Differences in percentiles of SBP distribution were compared using multivariate models with adjustment for age, race, sex, and US Census Bureau division. Results: Of the participants, 20,976 (80.3%) were classified as urban, 3,020 (11.6%) as large-rural, and 2,137 (8.2%) as small-isolated rural, reflecting the distribution of the population. The large-rural group had a 0.09 mmHg higher mean SBP compared to the urban group (95% CI, 0.33 to 1.52 mmHg, p = 0.0023), but the difference in SBP at the 95th percentile between these groups was 3.23 mmHg (95% CI, 1.43 to 4.73 mmHg, p = 0.0006). A similar difference was present between the small-isolated rural and urban groups at the highest percentiles. No urban-rural interaction was observed by race, sex, or US division. However, large SBP differences were present between US divisions, especially at the highest percentiles. To illustrate, SBP at the 95th percentile was 9.51 mmHg higher in the East North Central division than in the Pacific (95% CI, 6.41 to 12.61 mmHg, p < 0.0001). Conclusions: Residence in a rural area is associated with higher SBP, with larger differences at the highest percentiles of distribution. SBP differences are present between US divisions, independent of urban-rural status.

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Treatment Outcomes of Childhood Tuberculosis in Three Districts of Balochistan, Pakistan: Findings from a Retrospective Cohort Study

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa042 ◽

2020 ◽

Author(s):

Abid Abdullah ◽

Nafees Ahmad ◽

Muhammad Atif ◽

Shereen Khan ◽

Abdul Wahid ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Treatment Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

P Value ◽

Childhood Tb ◽

Study Sites ◽

Lost To Follow Up

Abstract Background This study aimed to evaluate treatment outcomes and factors associated unsuccessful outcomes among pediatric tuberculosis (TB) patients (age ≤14 years). Methods This was a retrospective cohort study conducted at three districts (Quetta, Zhob and Killa Abdullah) of Balochistan, Pakistan. All childhood TB patients enrolled for treatment at Bolan Medical Complex Hospital (BMCH) Quetta and District Headquarter Hospitals of Zhob and Killa Abdullah from 1 January 2016 to 31 December 2018 were included in the study and followed until their treatment outcomes were reported. Data were collected through a purpose developed standardized data collection form and analyzed by using SPSS 20. A p-value <0.05 was considered statistically significant. Results Out of 5152 TB patients enrolled at the study sites, 2184 (42.4%) were children. Among them, 1941 childhood TB patients had complete medical record were included in the study. Majority of the study participants were <5 years old (66.6%) and had pulmonary TB (PTB; 65%). A total of 45 (2.3%) patients were cured, 1680 (86.6%) completed treatment, 195 (10%) lost to follow-up, 15 (0.8%) died, 5 (0.3%) failed treatment and 1 (0.1%) was not evaluated for outcomes. In multivariate binary logistic regression analysis, treatment at BMCH Quetta (OR = 25.671, p-value < 0.001), rural residence (OR = 3.126, p-value < 0.001) and extra-PTB (OR = 1.619, p-value = 0.004) emerged as risk factors for unsuccessful outcomes. Conclusion The study sites collectively reached the World Health Organization’s target of treatment success (>85%). Lost to follow-up was the major reason for unsuccessful outcomes. Special attention to patients with identified risk factors for unsuccessful outcomes may improve outcomes further.

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