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Tuberculosis among economic migrants: a cross-sectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Viet Nam

Authors
  • Vo, Luan Nguyen Quang1, 2
  • Codlin, Andrew James1
  • Forse, Rachel Jeanette1
  • Nguyen, Hoa Trung3
  • Vu, Thanh Nguyen4
  • Van Truong, Vinh5
  • Do, Giang Chau5
  • Nguyen, Lan Huu5
  • Le, Giang Truong4
  • Caws, Maxine6, 7
  • 1 Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam , Ho Chi Minh City (Vietnam)
  • 2 Interactive Research and Development, Ho Chi Minh City, Viet Nam , Ho Chi Minh City (Vietnam)
  • 3 Go Vap District Health Center, Ho Chi Minh City, Viet Nam , Ho Chi Minh City (Vietnam)
  • 4 Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam , Ho Chi Minh City (Vietnam)
  • 5 Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam , Ho Chi Minh City (Vietnam)
  • 6 Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK , Liverpool (United Kingdom)
  • 7 Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal , Kathmandu (Nepal)
Type
Published Article
Journal
BMC Infectious Diseases
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Feb 12, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12879-020-4865-7
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundTuberculosis (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.MethodsThis 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 (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β6) and post-intervention trend (β7).ResultsShort-term, inter-province migrants experienced lower treatment success (aRR = 0.95 [95% CI: 0.92–0.99], p = 0.010) and higher loss to follow-up (aOR = 1.98 [95% CI: 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 [95% CI: 1.03–3.36], p = 0.041). There was evidence that patients > 55 years of age (aRR = 0.93 [95% CI: 0.89–0.96], p < 0.001), relapse patients (aRR = 0.89 [95% CI: 0.84–0.94], p < 0.001), and retreatment patients (aRR = 0.62 [95% CI: 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 [95% CI: 0.73–0.82], p < 0.001) and higher loss to follow-up (aOR = 2.18 [95% CI: 1.55–3.06], p < 0.001). The provision of treatment adherence support increased treatment success (IRR(β6) = 1.07 [95% CI: 1.00, 1.15], p = 0.041) and reduced loss to follow-up (IRR(β6) = 0.17 [95% CI: 0.04, 0.69], p = 0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β7) = 0.90 [95% CI: 0.83, 0.98], p = 0.019).ConclusionsEconomic 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.

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