Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study
Author
Berrocal-Almanza, Luis CLima, Marcela
Piotrowski, Helen
Botticello, Julie
Badhan, Amarjit
Karnani, Nisha
Kaur, Hanna
Pareek, Manish
Haldar, Pranabashis
Dedicoat, Martin
Kon, Onn Min
Zenner, Dominik
Lalvani, Ajit
Publication date
2023-08-17Subject
Respiratory medicine
Metadata
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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.Citation
Berrocal-Almanza LC, Lima M, Piotrowski H, Botticello J, Badhan A, Karnani N, Kaur H, Pareek M, Haldar P, Dedicoat M, Kon OM, Zenner D, Lalvani A. Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study. PLoS One. 2023 Aug 17;18(8):e0281918. doi: 10.1371/journal.pone.0281918. PMID: 37590225; PMCID: PMC10434856.Type
ArticleAdditional Links
http://www.plosone.org/PMID
37590225Journal
PLoS ONEPublisher
Public Library of Scienceae974a485f413a2113503eed53cd6c53
10.1371/journal.pone.0281918