Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, 5200, Eastern Cape, South Africa.
BMC Public Health. 2021 Mar 11;21(1):488. doi: 10.1186/s12889-021-10267-0.
Drug-resistant TB (DR-TB) remains a public health concern due to the high morbidity and mortality rates from the disease. The DR-TB is a multifaceted illness with expensive treatment regimens, toxic medications and most often the long duration of treatment constitutes a substantial financial burden on both infected patients and the health system. Despite significant research advances in the diagnosis and treatment, there is a paucity of synthesized evidence on how socio-economic factors are associated with DR-TB. This review aims to address this gap by synthesizing available evidence and data on the common socio-economic drivers of DR-TB infection in Africa.
A systematic search was conducted on PUBMED and Google Scholar databases from January 2011 to January 2020 using Joanna Briggs Institute's scoping review approach. An updated search was conducted on 21 September 2020. The eligibility criteria only included systematic reviews and studies with quantitative research methods (cross-sectional, case-control, cohort, and randomized-control trials). Studies conducted in Africa and focusing on socio-economic factors influencing DR-TB burden in African countries were also considered. Data was extracted from all the studies that met the eligibility criteria based on the study's objectives.
Out of the 154 articles that were retrieved for review, 20 abstracts of these articles met all the eligibility criteria. Of the 20 articles, 17 quantitative and 3 reviews. Two additional articles were found eligible, following the updated search. The following themes were identified as major findings: Social and economic drivers associated with DR-TB. Substance abuse of which, stigma and discrimination were the prominent social drivers. Economic drivers included poverty, financial constraints because of job loss, loss of productive time during hospital admission and treatment costs.
This review has highlighted which socio-economic factors contribute to DR- TB This is relevant to assist DR-TB management program and TB stakeholders in different settings to address identified socio-economic gaps and to reduce its negative impact on the programmatic management of DR TB. Therefore, redirecting strategies with more focus on socio-economic empowerment of DR-TB patients could be one of the innovative solutions to reduce the spread and eliminate DR-TB in Africa.
由于疾病的高发病率和死亡率，耐药结核病（DR-TB）仍然是一个公共卫生关注点。DR-TB 是一种多方面的疾病，治疗方案昂贵，药物毒性大，而且通常治疗时间长，这给感染患者和卫生系统都带来了巨大的经济负担。尽管在诊断和治疗方面取得了重大研究进展，但关于社会经济因素如何与 DR-TB 相关的综合证据仍然很少。本综述旨在通过综合非洲 DR-TB 感染的常见社会经济驱动因素的现有证据和数据来解决这一差距。
使用乔安娜布里格斯研究所的范围综述方法，在 PUBMED 和 Google Scholar 数据库中进行了系统搜索，时间范围为 2011 年 1 月至 2020 年 1 月。2020 年 9 月 21 日进行了更新搜索。入选标准仅包括系统评价和使用定量研究方法（横断面、病例对照、队列和随机对照试验）的研究。还考虑了在非洲进行的、侧重于影响非洲国家 DR-TB 负担的社会经济因素的研究。根据研究目的，从符合入选标准的所有研究中提取数据。
在检索到的 154 篇文章中，有 20 篇文章的摘要符合所有入选标准。在这 20 篇文章中，有 17 篇是定量研究，3 篇是综述。在更新搜索后，又发现了另外 2 篇符合条件的文章。确定了以下主题作为主要发现：与 DR-TB 相关的社会和经济驱动因素。社会驱动因素包括药物滥用、污名化和歧视。经济驱动因素包括贫困、失业导致的经济拮据、住院和治疗期间失去生产时间以及治疗费用。
本综述强调了哪些社会经济因素导致了 DR-TB。这对于帮助不同环境下的 DR-TB 管理项目和结核病利益相关者解决确定的社会经济差距，并减轻其对 DR-TB 规划管理的负面影响具有重要意义。因此，重新制定更侧重于 DR-TB 患者社会经济赋权的策略可能是减少 DR-TB 在非洲传播和消除 DR-TB 的创新解决方案之一。
