Tuberculosis treatment outcomes among precarious patients in France - 22/10/22
, D. Bachelet c, L. Han c, M. Dubert d, M. Parisey d, H. Cordel a, A. Bourgarit e, C. Bertrac f, S. Chauveau g, T. Billard-Pomares b, h, E. Carbonnelle b, h, O. Bouchaud a, i, Y. Yazdanpanah b, d, N. Vignier a, b, j, C. Laouénan b, cHighlights |
• | Patients lost to follow-up and treatment failure in tuberculosis disease (TB) are major public health issues. In the absence of appropriate treatment, approximately 70 % of smear-positive patients will die after 10 years. |
• | Patients with a history of tuberculosis and aged ≤ 24 years were associated with unfavorable treatment outcome. |
• | In our precarious population, socioeconomic conditions were not found to be associated with treatment failure. |
• | Insufficient weight gain at the beginning of treatment should be a warning sign, which may suggest unfavorable treatment outcome. |
Abstract |
Objectives |
Patients lost to follow-up and treatment failure in tuberculosis disease (TB) are major public health issues. In the absence of appropriate treatment, approximately 70 % of smear-positive patients will die within 10 years of disease progression. This study, conducted in the French region with the highest incidence, aimed to assess tuberculosis treatment outcomes and its determinants.
Patients and methods |
A prospective, multicenter cohort study (CO1TB) of adults and children treated for TB was conducted in four hospitals in the North of Paris. Treatment outcome at 1 year and associated socioeconomic and clinical factors were studied by multivariate logistic regression.
Results |
Among 145 TB cases included from May 2018 to January 2020, patients were mainly born abroad and most lived in difficult socioeconomic conditions. During treatment, 25/145 (17 %) patients experienced adverse effects, which were not significantly associated with discontinuation of treatment (p = 0.99). At 1 year, 114 (78 %) had completed treatments, 26 (19 %) were lost to follow-up, three (2.1 %) were still being treated and two (1.4 %) had died. In the multivariate analysis, a history of TB was significantly associated with unfavorable treatment outcome (aOR = 5.3, 95 %CI (1.5;18.6) and a trend towards significance (p < 0.2) was observed among patients aged under 24 years (aOR = 2.9, 95 %-CI 0.95;8.5).
Conclusion |
In this precarious population, socioeconomic conditions were not found to be associated with unfavorable treatment outcome, whereas history of tuberculosis and young age played a role. Increased monitoring is thus required for these patients.
Le texte complet de cet article est disponible en PDF.Keywords : France, Migrants, Treatment outcome, Tuberculosis
Plan
Vol 52 - N° 7
P. 389-395 - octobre 2022 Retour au numéro
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