Is distance associated with tuberculosis treatment outcomes? A retrospective cohort study in Kampala, Uganda
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMC infectious diseases
Abstract
Challenges accessing nearby health facilities may be a barrier to initiating and completing
tuberculosis (TB) treatment. We aimed to evaluate whether distance from residence to health facility chosen for
treatment is associated with TB treatment outcomes.
Methods: We conducted a retrospective cohort study of all patients initiating TB treatment at six health facilities in
Kampala from 2014 to 2016. We investigated associations between distance to treating facility and unfavorable TB
treatment outcomes (death, loss to follow up, or treatment failure) using multivariable Poisson regression.
Results: Unfavorable treatment outcomes occurred in 20% (339/1691) of TB patients. The adjusted relative risk (aRR)
for unfavorable treatment outcomes (compared to treatment success) was 0.87 (95% confidence interval [CI] 0.70,
1.07) for patients living ≥2 km from the facility compared to those living closer. When we separately compared
each type of unfavorable treatment outcome to favorable outcomes, those living ≥2 km from the facility had
increased risk of death (aRR 1.42 [95%CI 0.99, 2.03]) but decreased risk for loss to follow-up (aRR 0.57 [95%CI 0.41,
0.78]) than those living within 2 km.
Conclusions: Distance from home residence to TB treatment facility is associated with increased risk of death but
decreased risk of loss to follow up. Those who seek care further from home may have advanced disease, but once
enrolled may be more likely to remain in treatment.
Description
Keywords
Epidemiology, Health systems research, Geographic information systems
Citation
Robsky, K. O., Hughes, S., Kityamuwesi, A., Kendall, E. A., Kitonsa, P. J., Dowdy, D. W., & Katamba, A. (2020). Is distance associated with tuberculosis treatment outcomes? A retrospective cohort study in Kampala, Uganda. BMC infectious diseases, 20(1), 1-9. https://doi.org/10.1186/s12879-020-05099-z