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Research article
Luan Nguyen Quang Vo
Friends for International TB Relief
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5937-6286
License:
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Background: Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. Methods: This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series analysis to assess the impact of community-based adherence support on treatment outcomes. Results: Short-term, inter-province migrants experienced lower treatment success (aRR=0.95 [0.92-0.99], p=0.010) and higher loss to follow-up (aOR=1.98 [1.44-2.72], p<0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR=1.86 [1.03-3.36], p=0.041). There was evidence that patients >55 years of age (aRR=0.93 [0.89-0.96], p<0.001), relapse patients (aRR=0.89 [0.84-0.94], p<0.001), and retreatment patients (aRR=0.62 [0.52-0.75], p<0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR=0.77 [0.73-0.82], p<0.001) and higher loss to follow-up (aOR=2.18 [1.55-3.06], p<0.001). The provision of treatment adherence support increased treatment success (IRR(β 6 )=1.07 [1.00, 1.15], p=0.041) and reduced loss to follow-up (IRR(β 6 )=0.17 [0.04, 0.69], p=0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β 7 )=0.90 [0.83, 0.98], p=0.019). Conclusions: Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.
Keywords
adherence, tuberculosis, economic migrants, treatment outcomes, loss to follow-up, impact evaluation
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
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On 07 Feb, 2020
Editorial decision: Accept
On 07 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 05 Feb, 2020
Editor assigned
On 04 Feb, 2020
Submission checks complete
On 03 Feb, 2020
Editor invited
On 03 Feb, 2020
Version 2
Posted 27 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 01 Feb, 2020
Editor assigned
On 24 Jan, 2020
Submission checks complete
On 23 Jan, 2020
Editor invited
On 23 Jan, 2020
No comments provided
Review #2 received
Received 23 Dec, 2019
Editorial decision: Major revision
On 23 Dec, 2019
Reviewer #2 agreed
On 25 Sep, 2019
Review #1 received
Received 31 Aug, 2019
Reviewer #1 agreed
On 19 Aug, 2019
Reviewers invited
Invitations sent on 12 Jul, 2019
Editor assigned
On 11 Jul, 2019
Submission checks complete
On 11 Jul, 2019
Editor invited
On 11 Jul, 2019
First submitted
On 06 Jul, 2019
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Subject Areas
Infectious Diseases
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Luan Nguyen Quang Vo
Friends for International TB Relief
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5937-6286
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Submission checks complete
On 07 Feb, 2020
Editorial decision: Accept
On 07 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 05 Feb, 2020
Editor assigned
On 04 Feb, 2020
Submission checks complete
On 03 Feb, 2020
Editor invited
On 03 Feb, 2020
Version 2
Posted 27 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 01 Feb, 2020
Editor assigned
On 24 Jan, 2020
Submission checks complete
On 23 Jan, 2020
Editor invited
On 23 Jan, 2020
No comments provided
Review #2 received
Received 23 Dec, 2019
Editorial decision: Major revision
On 23 Dec, 2019
Reviewer #2 agreed
On 25 Sep, 2019
Review #1 received
Received 31 Aug, 2019
Reviewer #1 agreed
On 19 Aug, 2019
Reviewers invited
Invitations sent on 12 Jul, 2019
Editor assigned
On 11 Jul, 2019
Submission checks complete
On 11 Jul, 2019
Editor invited
On 11 Jul, 2019
First submitted
On 06 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background: Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. Methods: This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series analysis to assess the impact of community-based adherence support on treatment outcomes. Results: Short-term, inter-province migrants experienced lower treatment success (aRR=0.95 [0.92-0.99], p=0.010) and higher loss to follow-up (aOR=1.98 [1.44-2.72], p<0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR=1.86 [1.03-3.36], p=0.041). There was evidence that patients >55 years of age (aRR=0.93 [0.89-0.96], p<0.001), relapse patients (aRR=0.89 [0.84-0.94], p<0.001), and retreatment patients (aRR=0.62 [0.52-0.75], p<0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR=0.77 [0.73-0.82], p<0.001) and higher loss to follow-up (aOR=2.18 [1.55-3.06], p<0.001). The provision of treatment adherence support increased treatment success (IRR(β 6 )=1.07 [1.00, 1.15], p=0.041) and reduced loss to follow-up (IRR(β 6 )=0.17 [0.04, 0.69], p=0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β 7 )=0.90 [0.83, 0.98], p=0.019). Conclusions: Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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