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. 2023 Mar 21;18(3):e0282884.
doi: 10.1371/journal.pone.0282884. eCollection 2023.

Tuberculosis notifications in regional Victoria, Australia: Implications for public health care in a low incidence setting

Nompilo Moyo  1   2 , Ee Laine Tay  3 , James M Trauer  1   4 , Leona Burke  1 , Justin Jackson  5   6 , Robert J Commons  7   8 , Sarah C Boyd  9 , Kasha P Singh  10 , Justin T Denholm  1   10
Affiliations

Tuberculosis notifications in regional Victoria, Australia: Implications for public health care in a low incidence setting

Nompilo Moyo et al. PLoS One. .

Abstract

Background: Regionality is often a significant factor in tuberculosis (TB) management and outcomes worldwide. A wide range of context-specific factors may influence these differences and change over time. We compared TB treatment in regional and metropolitan areas, considering demographic and temporal trends affecting TB diagnosis and outcomes.

Methods: Retrospective analyses of data for patients notified with TB in Victoria, Australia, were conducted. The study outcomes were treatment delays and treatment outcomes. Multivariable Cox proportional hazard model analyses were performed to investigate the effect of regionality in the management of TB. Six hundred and eleven (7%) TB patients were notified in regional and 8,163 (93%) in metropolitan areas between 1995 and 2019. Of the 611 cases in the regional cohort, 401 (66%) were overseas-born. Fifty-one percent of the overseas-born patients in regional Victoria developed TB disease within five years of arrival in Australia. Four cases of multidrug-resistant tuberculosis were reported in regional areas, compared to 97 cases in metropolitan areas. A total of 3,238 patients notified from 2012 to 2019 were included in the survival analysis. The time follow-up for patient delay started at symptom onset date, and the event was the presentation to the healthcare centre. For healthcare system delay, follow-up time began at the presentation to the healthcare centre, and the event was commenced on TB treatment. Cases with extrapulmonary TB in regional areas have a non-significantly longer healthcare system delay than patients in metropolitan (median 64 days versus 54 days, AHR = 0.8, 95% CI 0.6-1.0, P = 0.094).

Conclusion: Tuberculosis in regional Victoria is common among the overseas-born population, and patients with extrapulmonary TB in regional areas experienced a non-significant minor delay in treatment commencement with no apparent detriment to treatment outcomes. Improving access to LTBI management in regional areas may reduce the burden of TB.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The flow of patients through the study.
Fig 2
Fig 2. Tuberculosis cases in regional Victoria by year of notification, age, and country of birth from 1995 to 2019.
Fig 3
Fig 3. Notified cases of tuberculosis in the overseas-born people in regional Victoria from 1995–2019 by the number of years since arrival in Australia.
Fig 4
Fig 4. Notified cases of tuberculosis in regional Victoria for overseas-born people from 1999 to 2019, by country of birth.
Fig 5
Fig 5. Kaplan-Meier curves in tuberculosis patients in Victoria, Australia from 2012 to 2019.
See this image and copyright information in PMC

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