Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 17;18(8):e0281918.
doi: 10.1371/journal.pone.0281918. eCollection 2023.

Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study

Luis C Berrocal-Almanza  1 , Marcela Lima  1 , Helen Piotrowski  1 , Julie Botticello  2 , Amarjit Badhan  1 , Nisha Karnani  1 , Hanna Kaur  3 , Manish Pareek  4 , Pranabashis Haldar  5 , Martin Dedicoat  3 , Onn Min Kon  1   6 , Dominik Zenner  1   7 , Ajit Lalvani  1   8
Affiliations

Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study

Luis C Berrocal-Almanza et al. PLoS One. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Main themes and codes derived from the participants’ perspectives.
GP general practitioner, DOT direct observation of therapy.
See this image and copyright information in PMC

References

    1. Public Health England (PHE). Public Health England (PHE). Tuberculosis in England report; 2021. [Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://assets.publishing.service.gov.uk/government/uploads/system/uploa....
    1. Trauer JM, Dodd PJ, Gomes MGM, Gomez GB, Houben R, McBryde ES, et al.. The Importance of Heterogeneity to the Epidemiology of Tuberculosis. Clin Infect Dis. 2019;69(1):159–66. doi: 10.1093/cid/ciy938 - DOI - PMC - PubMed
    1. Zenner D, Southern J, van Hest R, DeVries G, Stagg HR, Antoine D, et al.. Active case finding for tuberculosis among high-risk groups in low-incidence countries. Int J Tuberc Lung Dis. 2013;17(5):573–82. doi: 10.5588/ijtld.12.0920 - DOI - PubMed
    1. (PHE) PHE. Tackling TB in Under-Served Populations: A Resource for TB Control Boards and their partners 2017. 2017 [Available from: https://www.gov.uk/government/publications/tackling-tuberculosis-in-unde.... - PubMed
    1. Public Health England. Public Health England (PHE). Collaborative Tuberculosis Strategy for England 2015–2020 2015 [Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploa....

Publication types