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Which urban migrants default from tuberculosis treatment in Shanghai, China?

Chen J, Qi L, Xia Z, Shen M, Shen X, Mei J, DeRiemer K - PLoS ONE (2013)

Bottom Line: The presence of a cavity in the initial chest radiograph decreased the odds for a treatment default (OR, 0.87, 95% CI, 0.77-0.97, p=0.015), as did migration from central China (OR, 0.85, 95% CI, 0.73-0.99, p=0.042), case management by family members (OR, 0.73, 95% CI 0.66-0.81, p<0.0005), and the combination of case detection by a required physical exam and case management by health care staff (OR, 0.64, 95% CI, 0.45-0.93, p=0.019).Interventions that target retreated TB cases could also reduce treatment defaults among urban migrants.Health departments should develop effective measures to prevent treatment defaults among urban migrants, to ensure completion of therapy among urban migrants who move between cities and provinces, and to improve reporting of treatment outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.

ABSTRACT

Background: Migration is a major challenge to tuberculosis (TB) control worldwide. TB treatment requires multiple drugs for at least six months. Some TB patients default before completing their treatment regimen, which can lead to ongoing infectiousness and drug resistance.

Methods: We conducted a retrospective analysis of 29,943 active TB cases among urban migrants that were reported between 2000 to 2008 in Shanghai, China. We used logistic regression models to identify factors independently associated with treatment defaults in TB patients among urban migrants during 2005-2008.

Results: Fifty-two percent of the total TB patients reported in Shanghai during the study period were among urban migrants. Three factors increased the odds of a treatment default: case management using self-administered therapy (OR, 5.84, 95% CI, 3.14-10.86, p<0.0005), being a retreatment case (OR, 1.47, 95% CI, 1.25-1.71, p<0.0005), and age >60 years old (OR, 1.33, 95% CI, 1.05-1.67, p=0.017). The presence of a cavity in the initial chest radiograph decreased the odds for a treatment default (OR, 0.87, 95% CI, 0.77-0.97, p=0.015), as did migration from central China (OR, 0.85, 95% CI, 0.73-0.99, p=0.042), case management by family members (OR, 0.73, 95% CI 0.66-0.81, p<0.0005), and the combination of case detection by a required physical exam and case management by health care staff (OR, 0.64, 95% CI, 0.45-0.93, p=0.019).

Conclusion: Among TB patients who were urban migrants in Shanghai, case management using self-administered therapy was the strongest modifiable risk factor that was independently associated with treatment defaults. Interventions that target retreated TB cases could also reduce treatment defaults among urban migrants. Health departments should develop effective measures to prevent treatment defaults among urban migrants, to ensure completion of therapy among urban migrants who move between cities and provinces, and to improve reporting of treatment outcomes.

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Study population of active tuberculosis (TB) patients among urban migrants in Shanghai, 2000-2008.Cases with treatment outcomes other than treatment success or treatment default were excluded from the analyses. *Includes patients whose tests indicated they did not have tuberculosis and whose anti-TB therapy was therefore discontinued, and TB patients who were still on treatment after one year of therapy.
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pone-0081351-g001: Study population of active tuberculosis (TB) patients among urban migrants in Shanghai, 2000-2008.Cases with treatment outcomes other than treatment success or treatment default were excluded from the analyses. *Includes patients whose tests indicated they did not have tuberculosis and whose anti-TB therapy was therefore discontinued, and TB patients who were still on treatment after one year of therapy.

Mentions: Information about treatment outcomes and patient management among migrant TB patients was recorded and verified beginning in 2005. Therefore, we analyzed only the data from TB cases among urban migrants reported during 2005-2008 to identify the risk factors associated with a treatment default. We excluded cases with treatment outcomes other than treatment success or treatment default, such as transferring out of the municipality, death with TB, or other outcomes (Figure 1).


Which urban migrants default from tuberculosis treatment in Shanghai, China?

Chen J, Qi L, Xia Z, Shen M, Shen X, Mei J, DeRiemer K - PLoS ONE (2013)

Study population of active tuberculosis (TB) patients among urban migrants in Shanghai, 2000-2008.Cases with treatment outcomes other than treatment success or treatment default were excluded from the analyses. *Includes patients whose tests indicated they did not have tuberculosis and whose anti-TB therapy was therefore discontinued, and TB patients who were still on treatment after one year of therapy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3842957&req=5

pone-0081351-g001: Study population of active tuberculosis (TB) patients among urban migrants in Shanghai, 2000-2008.Cases with treatment outcomes other than treatment success or treatment default were excluded from the analyses. *Includes patients whose tests indicated they did not have tuberculosis and whose anti-TB therapy was therefore discontinued, and TB patients who were still on treatment after one year of therapy.
Mentions: Information about treatment outcomes and patient management among migrant TB patients was recorded and verified beginning in 2005. Therefore, we analyzed only the data from TB cases among urban migrants reported during 2005-2008 to identify the risk factors associated with a treatment default. We excluded cases with treatment outcomes other than treatment success or treatment default, such as transferring out of the municipality, death with TB, or other outcomes (Figure 1).

Bottom Line: The presence of a cavity in the initial chest radiograph decreased the odds for a treatment default (OR, 0.87, 95% CI, 0.77-0.97, p=0.015), as did migration from central China (OR, 0.85, 95% CI, 0.73-0.99, p=0.042), case management by family members (OR, 0.73, 95% CI 0.66-0.81, p<0.0005), and the combination of case detection by a required physical exam and case management by health care staff (OR, 0.64, 95% CI, 0.45-0.93, p=0.019).Interventions that target retreated TB cases could also reduce treatment defaults among urban migrants.Health departments should develop effective measures to prevent treatment defaults among urban migrants, to ensure completion of therapy among urban migrants who move between cities and provinces, and to improve reporting of treatment outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.

ABSTRACT

Background: Migration is a major challenge to tuberculosis (TB) control worldwide. TB treatment requires multiple drugs for at least six months. Some TB patients default before completing their treatment regimen, which can lead to ongoing infectiousness and drug resistance.

Methods: We conducted a retrospective analysis of 29,943 active TB cases among urban migrants that were reported between 2000 to 2008 in Shanghai, China. We used logistic regression models to identify factors independently associated with treatment defaults in TB patients among urban migrants during 2005-2008.

Results: Fifty-two percent of the total TB patients reported in Shanghai during the study period were among urban migrants. Three factors increased the odds of a treatment default: case management using self-administered therapy (OR, 5.84, 95% CI, 3.14-10.86, p<0.0005), being a retreatment case (OR, 1.47, 95% CI, 1.25-1.71, p<0.0005), and age >60 years old (OR, 1.33, 95% CI, 1.05-1.67, p=0.017). The presence of a cavity in the initial chest radiograph decreased the odds for a treatment default (OR, 0.87, 95% CI, 0.77-0.97, p=0.015), as did migration from central China (OR, 0.85, 95% CI, 0.73-0.99, p=0.042), case management by family members (OR, 0.73, 95% CI 0.66-0.81, p<0.0005), and the combination of case detection by a required physical exam and case management by health care staff (OR, 0.64, 95% CI, 0.45-0.93, p=0.019).

Conclusion: Among TB patients who were urban migrants in Shanghai, case management using self-administered therapy was the strongest modifiable risk factor that was independently associated with treatment defaults. Interventions that target retreated TB cases could also reduce treatment defaults among urban migrants. Health departments should develop effective measures to prevent treatment defaults among urban migrants, to ensure completion of therapy among urban migrants who move between cities and provinces, and to improve reporting of treatment outcomes.

Show MeSH
Related in: MedlinePlus