Mulholland Grace E, Herce Michael E, Bahemuka Ubaldo M, Kwena Zachary A, Jeremiah Kidola, Okech Brenda A, Bukusi Elizabeth, Okello Elialilia S, Nanyonjo Gertrude, Ssetaala Ali, Seeley Janet, Emch Michael, Pettifor Audrey, Weir Sharon S, Edwards Jessie K
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
PLOS Glob Public Health. 2023 Jun 5;3(6):e0001992. doi: 10.1371/journal.pgph.0001992. eCollection 2023.
Geographic mobility may disrupt continuity of care and contribute to poor clinical outcomes among people receiving treatment for tuberculosis (TB). This may occur especially where health services are not well coordinated across international borders, particularly in lower and middle income country settings. In this work, we describe mobility and the relationship between mobility and unfavorable TB treatment outcomes (i.e., death, loss to follow-up, or treatment failure) among a cohort of adults who initiated TB treatment at one of 12 health facilities near Lake Victoria. We abstracted data from health facility records for all 776 adults initiating TB treatment during a 6-month period at the selected facilities in Kenya, Tanzania, and Uganda. We interviewed 301 cohort members to assess overnight travel outside one's residential district/sub-county. In our analyses, we estimated the proportion of cohort members traveling in 2 and 6 months following initiation of TB treatment, explored correlates of mobility, and examined the association between mobility and an unfavorable TB treatment outcome. We estimated that 40.7% (95% CI: 33.3%, 49.6%) of people on treatment for TB traveled overnight at least once in the 6 months following treatment initiation. Mobility was more common among people who worked in the fishing industry and among those with extra-pulmonary TB. Mobility was not strongly associated with other characteristics examined, however, suggesting that efforts to improve TB care for mobile populations should be broad ranging. We found that in this cohort, people who were mobile were not at increased risk of an unfavorable TB treatment outcome. Findings from this study can help inform development and implementation of mobility-competent health services for people with TB in East Africa.
地理流动性可能会扰乱结核病（TB）患者的连续护理，并导致不良的临床结果。这种情况尤其可能发生在国际边境卫生服务协调不佳的地方，特别是在低收入和中等收入国家。在这项研究中，我们描述了维多利亚湖附近12家医疗机构之一开始接受结核病治疗的成年人群体中的流动性，以及流动性与不良结核病治疗结果（即死亡、失访或治疗失败）之间的关系。我们从肯尼亚、坦桑尼亚和乌干达选定医疗机构在6个月期间开始接受结核病治疗的所有776名成年人的医疗机构记录中提取了数据。我们采访了301名队列成员，以评估其在居住地区/县外的过夜旅行情况。在我们的分析中，我们估计了结核病治疗开始后2个月和6个月内出行的队列成员比例，探讨了流动性的相关因素，并研究了流动性与不良结核病治疗结果之间的关联。我们估计，40.7%（95%CI：33.3%，49.6%）的结核病治疗患者在治疗开始后的6个月内至少有一次过夜旅行。流动性在从事渔业的人群和患有肺外结核的人群中更为常见。然而，流动性与所检查的其他特征没有强烈关联，这表明改善流动人群结核病护理的努力应该是广泛的。我们发现，在这个队列中，流动的人出现不良结核病治疗结果的风险并没有增加。这项研究的结果有助于为东非为结核病患者提供具备流动性能力的卫生服务的开发和实施提供信息。
