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

• Type of Material: Article
• Authors: Simon Mutembo, University of Georgia; Jane N. Mutanga, University of Georgia; Kebby Musokotwane, Zambian Ministry of Health; Cuthbert Kanene, Centers for Disease Control and Prevention; Kevin Dobbin, University of Georgia; Xiaobai Yao, University of Georgia; Changwei Li, University of Georgia; Vincent Marconi, Emory University; Christopher C. Whalen, University of Georgia
• Language: English
• Date: 2019-12-30
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12879-019-4709-5
• Title of Journal or Parent Work: BMC Infectious Diseases
• ISSN: 1471-2334
• Volume: 19
• Issue: 1
• Start Page: 1087
• End Page: 1087
• Grant/Funding Information: This study was supported in part by the monitoring and evaluation unit of the provincial health office in southern province Zambia; and by grants from the National Institutes of Allergy and Infectious Disease (AI093856).
• Keywords: Recurrent tuberculosis; Treatment outcomes; Death; Urban; Rural
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

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.