Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020.
Background Tuberculosis (TB) is a preventable and a curable disease. In Brazil, TB treatment outcomes are particularly worse among homeless populations who are either of black race, malnourished or living with HIV/AIDS and other comorbidities. This study therefore evaluated factors associated with u...
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ftdoajarticles:oai:doaj.org/article:a58c0a0c126845098259ff3b7d3cc183 2023-12-10T09:46:16+01:00 Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. Osiyallê Akanni Silva Rodrigues Hammed Oladeji Mogaji Layana Costa Alves Renzo Flores-Ortiz Cleber Cremonese Joilda Silva Nery 2023-10-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0011685 https://doaj.org/article/a58c0a0c126845098259ff3b7d3cc183 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0011685 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0011685 https://doaj.org/article/a58c0a0c126845098259ff3b7d3cc183 PLoS Neglected Tropical Diseases, Vol 17, Iss 10, p e0011685 (2023) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2023 ftdoajarticles https://doi.org/10.1371/journal.pntd.0011685 2023-11-12T01:39:46Z Background Tuberculosis (TB) is a preventable and a curable disease. In Brazil, TB treatment outcomes are particularly worse among homeless populations who are either of black race, malnourished or living with HIV/AIDS and other comorbidities. This study therefore evaluated factors associated with unsuccessful TB treatment among homeless population (HP) compared to those with shelter. Methodology/principal findings The study population was composed of 284,874 people diagnosed with TB in Brazil between 2015 and 2020 and reported in the Information System for Notifiable Diseases (SINAN), among which 7,749 (2.72%) were homeless and 277,125 (97.28%) were sheltered. Cox regression analysis was performed with both populations to identify factors associated with unsuccessful TB treatment, and significant predictors of TB treatment outcomes. Results show that HP are more susceptible to unfavorable outcomes when compared to sheltered people (Hazard Ratio (HR): 2.04, 95% CI 1.82-2.28). Among the HP, illicit drug use (HR: 1.38, 95% CI 1.09-1.74), mental disorders (HR: 2.12, 95% CI 1.08-4.15) and not receiving directed observed treatment (DOT) (HR: 18.37, 95% CI 12.23-27.58) are significant predictors of poor treatment outcomes. The use of illicit drugs (HR: 1.53, 95% CI 1.21-1.93) and lack of DOT (HR: 17.97, 95% CI 11.71-27.59) are associated with loss to follow-up, while lack of DOT (HR: 15.66, 95% CI 4.79-51.15) was associated with mortality among TB patients. Conclusion/significance Homeless population living in Brazil are twice at risk of having an unsuccessful treatment, compared to those who are sheltered, with illicit drugs use, mental disorders and lack of DOT as risk factors for unsuccessful TB outcomes. Our findings reinforce the arguments for an intersectoral and integral approach to address these determinants of health among the vulnerable homeless populations. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 17 10 e0011685 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Osiyallê Akanni Silva Rodrigues Hammed Oladeji Mogaji Layana Costa Alves Renzo Flores-Ortiz Cleber Cremonese Joilda Silva Nery Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Tuberculosis (TB) is a preventable and a curable disease. In Brazil, TB treatment outcomes are particularly worse among homeless populations who are either of black race, malnourished or living with HIV/AIDS and other comorbidities. This study therefore evaluated factors associated with unsuccessful TB treatment among homeless population (HP) compared to those with shelter. Methodology/principal findings The study population was composed of 284,874 people diagnosed with TB in Brazil between 2015 and 2020 and reported in the Information System for Notifiable Diseases (SINAN), among which 7,749 (2.72%) were homeless and 277,125 (97.28%) were sheltered. Cox regression analysis was performed with both populations to identify factors associated with unsuccessful TB treatment, and significant predictors of TB treatment outcomes. Results show that HP are more susceptible to unfavorable outcomes when compared to sheltered people (Hazard Ratio (HR): 2.04, 95% CI 1.82-2.28). Among the HP, illicit drug use (HR: 1.38, 95% CI 1.09-1.74), mental disorders (HR: 2.12, 95% CI 1.08-4.15) and not receiving directed observed treatment (DOT) (HR: 18.37, 95% CI 12.23-27.58) are significant predictors of poor treatment outcomes. The use of illicit drugs (HR: 1.53, 95% CI 1.21-1.93) and lack of DOT (HR: 17.97, 95% CI 11.71-27.59) are associated with loss to follow-up, while lack of DOT (HR: 15.66, 95% CI 4.79-51.15) was associated with mortality among TB patients. Conclusion/significance Homeless population living in Brazil are twice at risk of having an unsuccessful treatment, compared to those who are sheltered, with illicit drugs use, mental disorders and lack of DOT as risk factors for unsuccessful TB outcomes. Our findings reinforce the arguments for an intersectoral and integral approach to address these determinants of health among the vulnerable homeless populations. |
format |
Article in Journal/Newspaper |
author |
Osiyallê Akanni Silva Rodrigues Hammed Oladeji Mogaji Layana Costa Alves Renzo Flores-Ortiz Cleber Cremonese Joilda Silva Nery |
author_facet |
Osiyallê Akanni Silva Rodrigues Hammed Oladeji Mogaji Layana Costa Alves Renzo Flores-Ortiz Cleber Cremonese Joilda Silva Nery |
author_sort |
Osiyallê Akanni Silva Rodrigues |
title |
Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. |
title_short |
Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. |
title_full |
Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. |
title_fullStr |
Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. |
title_full_unstemmed |
Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. |
title_sort |
factors associated with unsuccessful tuberculosis treatment among homeless persons in brazil: a retrospective cohort study from 2015 to 2020. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2023 |
url |
https://doi.org/10.1371/journal.pntd.0011685 https://doaj.org/article/a58c0a0c126845098259ff3b7d3cc183 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 17, Iss 10, p e0011685 (2023) |
op_relation |
https://doi.org/10.1371/journal.pntd.0011685 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0011685 https://doaj.org/article/a58c0a0c126845098259ff3b7d3cc183 |
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https://doi.org/10.1371/journal.pntd.0011685 |
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PLOS Neglected Tropical Diseases |
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17 |
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10 |
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e0011685 |
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