Drug resistance patterns of Mycobacterium tuberculosis complex and risk factors associated with multidrug-resistant tuberculosis in the upper southern part of Thailand

Background: this study aimed to assess the drug resistant pattern of Mycobacterium tuberculosis complex (MTBC) and the risk factors associated to multidrug-resistant tuberculosis cases (MDR-TB) in upper part of southern Thailand.  Methods: a total of 3238 TB cases was retrieved from a database of the office of prevention and control disease region 11. Only 1008 cases were confirmed by culture growth for Mycobacterium tuberculosis and drug-susceptibility testing (DST) during a period of 4 years (January 2013 to December 2016). The risk factors, including gender, age group, residence place, and history of treatment were analysed using multivariate logistic regression to predict the MDR-TB cases.  Results: among 1008 TB cases included in study, 77.4% of them were males, 31.5% lived in rural area with median age of 45.0 years (IQR = 23.0), 27.6% were retreatment for tuberculosis, 25.9%, 10.8%, 3.0%, 10.7% and 9.1 were determined to be resistant to isoniazid, rifampicin, ethambutol, streptomycin and MDR-TB, respectively. Adjusted odds ratios (95% confidence interval) of MDR-TB were 5.4 (2.68-11.03), and 4.2 (2.10, 8.45) for retreatment patients, and on treatment patients, respectively.  Conclusions: drug resistance tuberculosis is considerable problem in upper part of southern Thailand. Major risk factors involved previous history of TB treatment. Thus, it emphasizes on patients who had a history of previous TB treatment.&nbsp

Clusters of Drug-Resistant Mycobacterium tuberculosis Detected by Whole-Genome Sequence Analysis of Nationwide Sample, Thailand, 2014-2017.

Multidrug-resistant tuberculosis (MDR TB), pre-extensively drug-resistant tuberculosis (pre-XDR TB), and extensively drug-resistant tuberculosis (XDR TB) complicate disease control. We analyzed whole-genome sequence data for 579 phenotypically drug-resistant M. tuberculosis isolates (28% of available MDR/pre-XDR and all culturable XDR TB isolates collected in Thailand during 2014-2017). Most isolates were from lineage 2 (n = 482; 83.2%). Cluster analysis revealed that 281/579 isolates (48.5%) formed 89 clusters, including 205 MDR TB, 46 pre-XDR TB, 19 XDR TB, and 11 poly-drug-resistant TB isolates based on genotypic drug resistance. Members of most clusters had the same subset of drug resistance-associated mutations, supporting potential primary resistance in MDR TB (n = 176/205; 85.9%), pre-XDR TB (n = 29/46; 63.0%), and XDR TB (n = 14/19; 73.7%). Thirteen major clades were significantly associated with geography (p<0.001). Clusters of clonal origin contribute greatly to the high prevalence of drug-resistant TB in Thailand

Socio-demographic and AIDS-related factors associated with tuberculosis stigma in southern Thailand: a quantitative, cross-sectional study of stigma among patients with TB and healthy community members

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) remains one of the most important infectious diseases worldwide. A comprehensive approach towards disease control that addresses social factors including stigma is now advocated. Patients with TB report fears of isolation and rejection that may lead to delays in seeking care and could affect treatment adherence. Qualitative studies have identified socio-demographic, TB knowledge, and clinical determinants of TB stigma, but only one prior study has quantified these associations using formally developed and validated stigma scales. The purpose of this study was to measure TB stigma and identify factors associated with TB stigma among patients and healthy community members.</p> <p>Methods</p> <p>A cross-sectional study was performed in southern Thailand among two different groups of participants: 480 patients with TB and 300 healthy community members. Data were collected on socio-demographic characteristics, TB knowledge, and clinical factors. Scales measuring perceived TB stigma, experienced/felt TB stigma, and perceived AIDS stigma were administered to patients with TB. Community members responded to a community TB stigma and community AIDS stigma scale, which contained the same items as the perceived stigma scales given to patients. Stigma scores could range from zero to 30, 33, or 36 depending on the scale. Three separate multivariable linear regressions were performed among patients with TB (perceived and experience/felt stigma) and community members (community stigma) to determine which factors were associated with higher mean TB stigma scores.</p> <p>Results</p> <p>Only low level of education, belief that TB increases the chance of getting AIDS, and AIDS stigma were associated with higher TB stigma scores in all three analyses. Co-infection with HIV was associated with higher TB stigma among patients. All differences in mean stigma scores between index and referent levels of each factor were less than two points, except for incorrectly believing that TB increases the chance of getting AIDS (mean difference of 2.16; 95% CI: 1.38, 2.94) and knowing someone who died from TB (mean difference of 2.59; 95% CI: 0.96, 4.22).</p> <p>Conclusion</p> <p>These results suggest that approaches addressing the dual TB/HIV epidemic may be needed to combat TB stigma and that simply correcting misconceptions about TB may have limited effects.</p

Accountability of directly observed treatment (DOT) for tuberculosis in lower part of Southern Thailand (Region 12) : interrelationship between DOT observer in practice, compliance to the DOT principle, and treatment outcomes

Thesis (Ph.D., Epidemiology)--Prince of Songkla University, 200

P-MS008 RISK FACTORS FOR RECURRENCE OF PULMONARY TUBERCULOSIS IN NAN PROVINCE

Abstract Background: Recurrence of pulmonary tuberculosis can be both due to re-infection and relapse has been previously treated for TB disease. The recurrence of pulmonary tuberculosis remains unclear and has potential implications for public health. This study aims to estimate the incidence of, and investigate risk factors for, recurrent episodes of tuberculosis in Nan province. Method: Episodes of recurrent cases of tuberculosis data using a TB clinic management program (TBCM) database, office of disease prevention and control, 10; Thailand , during January 2005 to December 2012. A new clinical and/or microbiological TB diagnosis in the cure or completion treatment patients was defined as a recurrent TB. To estimate the incidence and follow-up time, recurrence or censored was calculated. Poisson regression was used to determine risk factors, socio-demographic, history of tuberculosis treatment and comorbid condition factor, for recurrent pulmonary tuberculosis. Results: Among the total 2011 cases report, 136 patients were resulting in recurrence of pulmonary tuberculosis (recurrence rate 20.37 per 1000 person-years of follow-up). The results of the present study indicate that older than 50 years old (IRR 1.43; 95% CI 1.01-2.05), BMI underweight (IRR 2.06; 95% CI 1.37 -3.10), sputum smear positive at 2 months (IRR 1.92; 95% CI 1.22-3.03), abnormal chest radiography presented cavitation (IRR1.91; 95% CI 1.07-3.42) and HIV-positive patients (IRR 3.30; were associated with recurrence of pulmonary tuberculosis at the multivariate level. Conclusion: The older age at discharge, BMI underweight, sputum smear positive at 2 months, abnormal chest radiography presented cavitation and HIV-positive patients are strongly associated with recurrence of pulmonary tuberculosis. These factors should be considered when planning, surveillance, prevention and control TB program

Catastrophic costs incurred by tuberculosis affected households from Thailand's first national tuberculosis patient cost survey.

Tuberculosis (TB) causes an economic impact on the patients and their households. Although Thailand has expanded the national health benefit package for TB treatment, there was no data on out-of-pocket payments and income losses due to TB from patients and their household perspectives. This national TB patient cost survey was conducted to examine the TB-related economic burden, and assess the proportion of TB patients and their households facing catastrophic total costs because of TB disease. A cross-sectional TB patient cost survey was employed following WHO methods. Structured interviews with a paper-based questionnaire were conducted from October 2019 to July 2021. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2021 and estimated throughout pre- and post-TB diagnosis episodes. We assessed the proportion of TB-affected households facing costs > 20% of household expenditure due to TB. We analyzed 1400 patients including 1382 TB (first-line treatment) and 18 drug-resistant TB patients (DR-TB). The mean total costs per TB episode for all study participants were 903 USD (95% confident interval; CI 771-1034 USD). Of these, total direct non-medical costs were the highest costs (mean, 402 USD, and 95%CI 334-470 USD) incurred per TB-affected household followed by total indirect costs (mean, 393 USD, and 95%CI 315-472 USD) and total direct medical costs (mean, 107 USD, and 95%CI 81-133 USD, respectively. The proportion of TB-affected households facing catastrophic costs was 29.5% (95%CI 25.1-34.0%) for TB (first-line), 61.1% (95%CI 29.6-88.1%) for DR-TB and 29.9% (95%CI 25.6-34.4%) overall. This first national survey highlighted the economic burden on TB-affected households. Travel, food/nutritional supplementation, and indirect costs contribute to a high proportion of catastrophic total costs. These suggest the need to enhance financial and social protection mechanisms to mitigate the financial burden of TB-affected households

Migrant workers’ occupation and healthcare-seeking preferences for TB-suspicious symptoms and other health problems: a survey among immigrant workers in Songkhla province, southern Thailand

<p>Abstract</p> <p>Background</p> <p>Much of the unskilled and semi-skilled workforce in Thailand comprises migrant workers from neighbouring countries. While, in principle, healthcare facilities in the host country are open to those migrants registered with the Ministry of Labour, their actual healthcare-seeking preferences and practices, as well as those of unregistered migrants, are not well documented. This study aimed to describe the patterns of healthcare-seeking behaviours of immigrant workers in Thailand, emphasizing healthcare practices for TB-suspicious symptoms, and to identify the role of occupation and other factors influencing these behaviours.</p> <p>Methods</p> <p>A survey was conducted among 614 immigrant factory workers (FW), rubber tappers (RT) and construction workers (CW), in which information was sought on socio-demography, history of illness and related healthcare-seeking behaviour. Mixed effects logistic regression modeling was employed in data analysis.</p> <p>Results</p> <p>Among all three occupations, self-medication was the most common way of dealing with illnesses, including the development of TB-suspicious symptoms, for which inappropriate drugs were used. Only for GI symptoms and obstetric problems did migrant workers commonly seek healthcare at modern healthcare facilities. For GI illness, FW preferred to attend the in-factory clinic and RT a private facility over government facilities owing to the quicker service and greater convenience. For RT, who were generally wealthier, the higher cost of private treatment was not a deterrent. CW preferentially chose a government healthcare facility for their GI problems. For obstetric problems, including delivery, government facilities were utilized by RT and CW, but most FW returned to their home country. After adjusting for confounding, having legal status in the country was associated with overall greater use of government facilities and being female and being married with use of both types of modern healthcare facility. One-year estimated period prevalence of TB-suspicious symptoms was around 6% among FW but around 27% and 30% in RT and CW respectively. However, CW were the least likely to visit a modern healthcare facility for these symptoms.</p> <p>Conclusions</p> <p>Self medication is the predominant mode of healthcare seeking among these migrant workers. When accessing a modern healthcare facility the choice is influenced by occupation and its attendant lifestyle and socioeconomic conditions. Utilization of modern facilities could be improved by reducing the current barriers by more complete registration coverage and better provision of healthcare information, in which local vendors of the same ethnicity could play a useful role. Active surveillance for TB among migrant workers, especially CW, may lead to better TB control.</p