Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
17
10
2022
accepted:
05
02
2023
medline:
21
8
2023
pubmed:
17
8
2023
entrez:
17
8
2023
Statut:
epublish
Résumé
Evidence on factors contributing to poor treatment outcome and healthcare priorities in vulnerable populations affected by tuberculosis (TB) in urban areas of England other than London is needed to inform setting-specific prevention and care policies. We addressed this knowledge gap in a cohort of TB patients and healthcare providers in Birmingham and Leicester, UK. A mixed-methods study was performed. Logistic regression was used to identify TB patients more likely to have poor treatment outcomes according to clinical and demographic characteristics and social risk factors (SRFs) in a 2013-18 cohort. 25 semi-structured interviews were undertaken in purposely selected individuals (9 patients and 16 healthcare professionals) to glean insights on their healthcare priorities and the factors that contribute to poor treatment outcome. The quantitative cohort comprised 2252 patients. Those who were ≥ 55 years of age, foreign-born from Central Europe, East Asia and Sub Saharan Africa and with MDR-TB were more likely to have poor treatment outcomes. According to patients and healthcare professionals, the factors that contribute to vulnerability to develop TB and poor treatment outcomes include poor working and living conditions, inadequate or absent welfare protection, poor primary healthcare responsiveness, treatment duration and side effects. These factors could be addressed by increased networking, partnership and integration between healthcare and social services and better integration between primary and secondary healthcare. In both cities, being ≥ 55 years of age, having MDR-TB and being of foreign-birth are predictors of unfavourable treatment outcome. Risk of poor treatment outcome and vulnerability seem to be multidimensional. A better understanding of specific vulnerabilities and how they affect patient care pathway is needed to design adequate support programmes.
Sections du résumé
BACKGROUND
Evidence on factors contributing to poor treatment outcome and healthcare priorities in vulnerable populations affected by tuberculosis (TB) in urban areas of England other than London is needed to inform setting-specific prevention and care policies. We addressed this knowledge gap in a cohort of TB patients and healthcare providers in Birmingham and Leicester, UK.
METHODS
A mixed-methods study was performed. Logistic regression was used to identify TB patients more likely to have poor treatment outcomes according to clinical and demographic characteristics and social risk factors (SRFs) in a 2013-18 cohort. 25 semi-structured interviews were undertaken in purposely selected individuals (9 patients and 16 healthcare professionals) to glean insights on their healthcare priorities and the factors that contribute to poor treatment outcome.
RESULTS
The quantitative cohort comprised 2252 patients. Those who were ≥ 55 years of age, foreign-born from Central Europe, East Asia and Sub Saharan Africa and with MDR-TB were more likely to have poor treatment outcomes. According to patients and healthcare professionals, the factors that contribute to vulnerability to develop TB and poor treatment outcomes include poor working and living conditions, inadequate or absent welfare protection, poor primary healthcare responsiveness, treatment duration and side effects. These factors could be addressed by increased networking, partnership and integration between healthcare and social services and better integration between primary and secondary healthcare.
CONCLUSIONS
In both cities, being ≥ 55 years of age, having MDR-TB and being of foreign-birth are predictors of unfavourable treatment outcome. Risk of poor treatment outcome and vulnerability seem to be multidimensional. A better understanding of specific vulnerabilities and how they affect patient care pathway is needed to design adequate support programmes.
Identifiants
pubmed: 37590225
doi: 10.1371/journal.pone.0281918
pii: PONE-D-22-28286
pmc: PMC10434856
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0281918Subventions
Organisme : Medical Research Council
ID : MR/V027549/1
Pays : United Kingdom
Informations de copyright
Copyright: © 2023 Berrocal-Almanza et al. 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 original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
BMJ. 2013 Jun 28;346:f4130
pubmed: 23810959
Lancet Infect Dis. 2019 Nov;19(11):1191-1201
pubmed: 31471131
J Public Health (Oxf). 2017 Jun 1;39(2):219-220
pubmed: 28605764
Annu Rev Med. 2019 Jan 27;70:105-120
pubmed: 30403551
Lancet. 2005 Mar 19-25;365(9464):1099-104
pubmed: 15781105
Health Aff (Millwood). 2007 Sep-Oct;26(5):1220-30
pubmed: 17848429
Thorax. 2007 Aug;62(8):667-71
pubmed: 17289861
Lancet. 2018 Jan 20;391(10117):186-188
pubmed: 29137870
Clin Infect Dis. 2019 Jun 18;69(1):159-166
pubmed: 30383204
Int J Tuberc Lung Dis. 2019 May 1;23(5):563-570
pubmed: 31097064
J Public Health (Oxf). 2019 Mar 1;41(1):201-202
pubmed: 29509909
Soc Sci Med. 2005 Jun;60(11):2417-30
pubmed: 15814168
Lancet Public Health. 2022 Apr;7(4):e305-e315
pubmed: 35338849
BMJ. 2011 Sep 14;343:d5376
pubmed: 22067473
Health Serv Res. 2013 Dec;48(6 Pt 2):2134-56
pubmed: 24279835
Eur Respir J. 2016 Oct;48(4):1233-1236
pubmed: 27587555
Br Med Bull. 2016 Jun;118(1):16-24
pubmed: 27151953
Int J Tuberc Lung Dis. 2013 May;17(5):573-82
pubmed: 23575321
Camb Q Healthc Ethics. 2009 Apr;18(2):113-21
pubmed: 19250564
BMJ. 2015 Jun 16;350:h3056
pubmed: 26080047