A Carroll1, M Vincenti-Delmas2, B Maung Maung2, W P P Htun2, F Nosten3, C Smith1, P Sonnenberg1. 1. Institute for Global Health, University College London, London, UK. 2. Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot Tak, Thailand. 3. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK.
Abstract
BACKGROUND: Cross-border migrants at the Thailand-Myanmar border are an underserved and vulnerable population. We aimed to identify the causes and risk factors for TB mortality at a migrant-friendly TB programme. METHODS: Routinely collected data on TB cases, treatment outcomes and causes of death were analysed for adult TB cases diagnosed between January 2013 and April 2017. Mortality in the 6 months post-diagnosis was calculated and risk factors were identified using multivariable Poisson regression. RESULTS: Of the 1344 TB cases diagnosed, 1005 started treatment and 128 died. Case fatality rate was 9.5% and the TB mortality rate was 2.4/100 person-months. The number of pre-treatment deaths (33/128) and losses to follow-up (9.0%) were high. Among cases enrolled in treatment, the treatment success rate was 79.8%. When stratified by HIV status, case fatality was higher in HIV-positive cases not on antiretroviral therapy (ART) (90.3%) or with unknown HIV status (31.8%) than those on ART (14.3%) or HIV-negative (8.6%). CONCLUSION: This TB programme achieved high treatment success rates in a population with a substantial burden of TB-HIV coinfection. Expanding access to HIV testing and ART is crucial to reduce mortality. Striving towards same-day TB diagnosis and treatment could reduce death and loss to follow-up.
BACKGROUND: Cross-border migrants at the Thailand-Myanmar border are an underserved and vulnerable population. We aimed to identify the causes and risk factors for TBmortality at a migrant-friendly TB programme. METHODS: Routinely collected data on TB cases, treatment outcomes and causes of death were analysed for adult TB cases diagnosed between January 2013 and April 2017. Mortality in the 6 months post-diagnosis was calculated and risk factors were identified using multivariable Poisson regression. RESULTS: Of the 1344 TB cases diagnosed, 1005 started treatment and 128 died. Case fatality rate was 9.5% and the TBmortality rate was 2.4/100 person-months. The number of pre-treatment deaths (33/128) and losses to follow-up (9.0%) were high. Among cases enrolled in treatment, the treatment success rate was 79.8%. When stratified by HIV status, case fatality was higher in HIV-positive cases not on antiretroviral therapy (ART) (90.3%) or with unknown HIV status (31.8%) than those on ART (14.3%) or HIV-negative (8.6%). CONCLUSION: This TB programme achieved high treatment success rates in a population with a substantial burden of TB-HIV coinfection. Expanding access to HIV testing and ART is crucial to reduce mortality. Striving towards same-day TB diagnosis and treatment could reduce death and loss to follow-up.