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

Abstract

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.

Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies

“…Forty-six studies were included in the meta-analysis, seven of which were RCTs [ 4 , 30 – 74 ]. Six CSs included primarily HIV/TB patients [ 51 , 53 – 55 , 57 , 72 ] and two CSs involved primarily MDR-TB patients [ 56 , 72 ].…”

Factors associated with directly observed treatment in tuberculosis/HIV coinfection cases in Porto Alegre, 2009-2013: A retrospective cohort

“…Notwithstanding, the district has a health center that is historically considered one of the pioneers in tuberculosis treatment [18]. Sex and age were not associated with the outcome, as in other studies that point out that these are not decisive factors for the performance of DOT [31–33]. In terms of sociodemographic variables, data on race and schooling show the vulnerability associated with DOT.…”

Prevalência e fatores associados ao abandono do tratamento da tuberculose

“…A forma extrapulmonar foi identificada nesta pesquisa como fator de decréscimo do abandono do tratamento. Corroborando esses achados, estudos (21)(22)(23) também identificaram a diminuição do abandono do tratamento quando as formas não pulmonares são manifestadas. Por outro lado, estudo realizado no Paquistão (24) não encontrou associações significantes e investigação desenvolvida na Malásia (25) apontou aumento dos desfechos desfavoráveis quando a manifestação é extrapulmonar.…”