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Tuberculosis treatment outcomes amongst disadvantaged patients in India

Jackson, C; Stagg, HR; Doshi, A; Pan, D; Sinha, A; Batra, R; Batra, S; ... Lipman, M; + view all (2017) Tuberculosis treatment outcomes amongst disadvantaged patients in India. Public Health Action , 7 (2) pp. 134-140. 10.5588/pha.16.0107. Green open access

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Abstract

Setting: Urban slums and poor rural areas, India, 2012-2014. Objective: To describe characteristics of tuberculosis (TB) patients enrolled in treatment through Operation ASHA, a non-governmental organisation serving disadvantaged populations in India, and to identify risk factors for unfavourable treatment outcomes. Design: Retrospective cohort study. Patient characteristics were assessed for their relationship with treatment outcomes using mixed effects logistic regression adjusting for clustering by treatment centre and Indian state. Outcomes were considered favourable (cured/treatment completed) or unfavourable (treatment failure, loss to follow-up, death, switch to multi-drug resistant TB treatment, transfer out). Results: 7148/8415 (84.9%) patients had a favourable outcome. On multivariable analysis, unfavourable outcomes were more common amongst men (odds ratio [OR]=1.31, 95% confidence interval [CI] 1.15-1.51), older patients (OR=1.12 [1.04-1.21]) and previously treated patients (OR=2.05 [1.79-2.36]). Compared to pulmonary smear-negative patients, those with extra-pulmonary disease were less likely (OR=0.72 [0.60-0.87]) whilst smear-positive pulmonary patients were more likely to have unfavourable outcomes (OR=1.38 [1.15-1.66] for low [scanty/1+] and OR=1.71 [1.44-2.04] high [2+/3+] positive smears, respectively). Conclusion: The treatment success rate within Operation ASHA is comparable to that reported nationally for India. Men, older patients, retreatment cases and smear-positive pulmonary TB patients may need additional interventions to ensure a favourable outcome.

Type: Article
Title: Tuberculosis treatment outcomes amongst disadvantaged patients in India
Open access status: An open access version is available from UCL Discovery
DOI: 10.5588/pha.16.0107
Publisher version: http://dx.doi.org/10.5588/pha.16.0107
Language: English
Additional information: Copyright © 2017 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the riginal author and source are credited.
Keywords: Epidemiology, Directly observed therapy, Slums, Mycobacteria
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/1541110
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