Risk factors for differential outcome following directly observed treatment (DOT) of slum and non-slum tuberculosis patients: a retrospective cohort study

BMC Infectious Diseases

Research Article

Lee W. Riley¹  Robert E. Snyder¹  Mariel A. Marlow¹  Ethel Leonor Noia Maciel²  Melissa E. Phuphanich³ 

[1] Division of Infectious Diseases and Vaccinology and Division of Epidemiology, School of Public Health, University of California, 94720, Berkeley, CA, USA;Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1468 Maruípe, Vitória, ES, Brazil;Rush Medical College, 600 S Paulina St, 60612, Chicago, IL, USA;

关键词: Tuberculosis treatment outcome;    Directly observed treatment;    Tuberculosis cure;    Urban poverty;    Slum;   

DOI  :  10.1186/s12879-016-1835-1

 received in 2015-08-10, accepted in 2016-09-14,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundBrazil’s National Tuberculosis Control Program seeks to improve tuberculosis (TB) treatment in vulnerable populations. Slum residents are more vulnerable to TB due to a variety of factors, including their overcrowded living conditions, substandard infrastructure, and limited access to healthcare compared to their non-slum dwelling counterparts. Directly observed treatment (DOT) has been suggested to improve TB treatment outcomes among vulnerable populations, but the program’s differential effectiveness among urban slum and non-slum residents is not known.MethodsWe retrospectively compared the impact of DOT on TB treatment outcome in residents of slum and non-slum census tracts in Rio de Janeiro reported to the Brazilian Notifiable Disease Database in 2010. Patient residential addresses were geocoded to census tracts from the 2010 Brazilian Census, which were identified as slum (aglomerados subnormais -AGSN) and non-slum (non-AGSN) by the Census Bureau. Homeless and incarcerated cases as well as those geocoded outside the city’s limits were excluded from analysis.ResultsIn 2010, 6,601 TB cases were geocoded within Rio de Janeiro; 1,874 (27.4 %) were residents of AGSN, and 4,794 (72.6 %) did not reside in an AGSN area. DOT coverage among AGSN cases was 35.2 % (n = 638), while the coverage in non-AGSN cases was 26.2 % (n = 1,234). Clinical characteristics, treatment, follow-up, cure, death and abandonment were similar in both AGSN and non-AGSN TB patients. After adjusting for covariates, AGSN TB cases on DOT had 1.67 (95 % CI: 1.17, 2.4) times the risk of cure, 0.61 (95 % CI: 0.41, 0.90) times the risk of abandonment, and 0.1 (95 % CI: 0.01, 0.77) times the risk of death from TB compared to non-AGSN TB cases not on DOT.ConclusionWhile DOT coverage was low among TB cases in both AGSN and non-AGSN communities, it had a greater impact on TB cure rate in AGSN than in non-AGSN populations in the city of Rio de Janeiro.

【 授权许可】

CC BY   
© The Author(s). 2016