Jessica Rutledge Bruce Musselman Bestrashniy1, Viet Nhung Nguyen2, Thi Loi Nguyen1, Thi Lieu Pham1, Thu Anh Nguyen1, Duc Cuong Pham1, Le Phuong Hoa Nghiem1, Thi Ngoc Anh Le2, Binh Hoa Nguyen3, Kim Cuong Nguyen4, Huy Dung Nguyen5, Tran Ngoc Buu1, Thi Nhung Le1, Viet Hung Nguyen1, Ngoc Sy Dinh2, Warwick John Britton6, Guy Barrington Marks7, Greg James Fox8. 1. Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia. 2. National Lung Hospital, Ba Dinh, Hanoi, Vietnam. 3. National Lung Hospital, Ba Dinh, Hanoi, Vietnam; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France. 4. National Lung Hospital, Ba Dinh, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam. 5. Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam. 6. Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Camperdown, NSW, 2050, Australia; Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia. 7. Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia. 8. Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia; Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia. Electronic address: greg.fox@sydney.edu.au.
Abstract
BACKGROUND: Patients completing treatment for tuberculosis (TB) in high-prevalence settings face a risk of developing recurrent disease. This has important consequences for public health, given its association with drug resistance and a poor prognosis. Previous research has implicated individual factors such as smoking, alcohol use, HIV, poor treatment adherence, and drug resistant disease as risk factors for recurrence. However, little is known about how these factors co-act to produce recurrent disease. Furthermore, perhaps factors related to the index disease means higher burden/low resource settings may be more prone to recurrent disease that could be preventable. METHODS: We conducted a case-control study nested within a cohort of consecutively enrolled adults who were being treated for smear positive pulmonary TB in 70 randomly selected district clinics in Vietnam. Cases were patients with recurrent TB, identified by follow-up from the parent cohort study. Controls were selected from the cohort by random sampling. Information on demographic, clinical and disease-related characteristics was obtained by interview. Treatment information was extracted from clinic registries. Logistic regression, with stepwise selection, was used to develop a fully adjusted model for the odds of recurrence of TB. RESULTS: We recruited 10,964 patients between October 2010 and July 2013. Median follow-up was 988 days. At the end of follow-up, 505 patients (4.7%) with recurrence were identified as cases and 630 other patients were randomly selected as controls. Predictors of recurrence included multidrug-resistant (MDR)-TB (adjusted odds ratio 79.6; 95% CI: 25.1-252.0), self-reported prior TB therapy (aOR=2.5; 95% CI: 1.7-3.5), and incomplete adherence (aOR=1.9; 95% CI 1.1-3.1). CONCLUSIONS: Index disease treatment history is a leading determinant of relapse among patients with TB in Vietnam. Further research is required to identify interventions that will reduce the risk of recurrent disease and enhance its early detection within high-risk populations. Crown
BACKGROUND:Patients completing treatment for tuberculosis (TB) in high-prevalence settings face a risk of developing recurrent disease. This has important consequences for public health, given its association with drug resistance and a poor prognosis. Previous research has implicated individual factors such as smoking, alcohol use, HIV, poor treatment adherence, and drug resistant disease as risk factors for recurrence. However, little is known about how these factors co-act to produce recurrent disease. Furthermore, perhaps factors related to the index disease means higher burden/low resource settings may be more prone to recurrent disease that could be preventable. METHODS: We conducted a case-control study nested within a cohort of consecutively enrolled adults who were being treated for smear positive pulmonary TB in 70 randomly selected district clinics in Vietnam. Cases were patients with recurrent TB, identified by follow-up from the parent cohort study. Controls were selected from the cohort by random sampling. Information on demographic, clinical and disease-related characteristics was obtained by interview. Treatment information was extracted from clinic registries. Logistic regression, with stepwise selection, was used to develop a fully adjusted model for the odds of recurrence of TB. RESULTS: We recruited 10,964 patients between October 2010 and July 2013. Median follow-up was 988 days. At the end of follow-up, 505 patients (4.7%) with recurrence were identified as cases and 630 other patients were randomly selected as controls. Predictors of recurrence included multidrug-resistant (MDR)-TB (adjusted odds ratio 79.6; 95% CI: 25.1-252.0), self-reported prior TB therapy (aOR=2.5; 95% CI: 1.7-3.5), and incomplete adherence (aOR=1.9; 95% CI 1.1-3.1). CONCLUSIONS: Index disease treatment history is a leading determinant of relapse among patients with TB in Vietnam. Further research is required to identify interventions that will reduce the risk of recurrent disease and enhance its early detection within high-risk populations. Crown
Authors: Helen R Stagg; Mary Flook; Antal Martinecz; Karina Kielmann; Pia Abel Zur Wiesch; Aaron S Karat; Marc C I Lipman; Derek J Sloan; Elizabeth F Walker; Katherine L Fielding Journal: ERJ Open Res Date: 2020-11-02