TY - JOUR
T1 - TB case fatality and recurrence in a private sector cohort in Mumbai, India
AU - Huddart, S.
AU - Ingawale, P.
AU - Edwin, J.
AU - Jondhale, V.
AU - Pai, M.
AU - Benedetti, A.
AU - Shah, D.
AU - Vijayan, S.
N1 - Funding Information:
The fieldwork in Mumbai was supported by a grant from the Bill & Melinda Gates Foundation, Seattle, WA, USA (BMGF OPP1091843P). SH was supported by a Fonds de recherche du Québec – Santé Doctoral Fellowship. Conflict of interests: none declared.
Publisher Copyright:
© 2021 International Union against Tubercul. and Lung Dis.. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - BACKGROUND: Half of India's three million TB patients are treated in the largely unregulated private sector, where quality of care is often poor. Private provider interface agencies (PPIAs) seek to improve private sector quality of care, which can be measured in terms of case fatality and recurrence rates. METHODS : We conducted a retrospective cohort survey of 4,000 private sector patients managed by the PATH PPIA between 2014 and 2017. We estimated treatment and post-treatment case-fatality ratios (CFRs) and recurrence rates. We used Cox proportional hazards models to identify predictors of fatality and recurrence. Patient loss to follow-up was adjusted for using selection weighting. RESULTS : The treatment CFR was 7.1% (95% CI 6.0-8.2). At 24 months post-treatment, the CFR was 2.4% (95% CI 1.7-3.0) and the recurrence rate was 1.9% (95% CI 1.3-2.5). Treatment fatality was associated with age (HR 1.02, 95% CI 1.02-1.03), clinical diagnosis (HR 0.61, 95% CI 0.45-0.84), treatment duration (HR 0.09, 95% CI 0.06-0.10) and adherence. Post-treatment fatality was associated with treatment duration (HR 0.87, 95% CI 0.79- 0.91) and adherence. CONCLUSIONS : We found a moderate treatment phase CFR among PPIA-managed private sector patient with low rates of post-treatment fatality and recurrence. Routine monitoring of patient outcomes after treatment would strengthen PPIAs and inform future post TB interventions.
AB - BACKGROUND: Half of India's three million TB patients are treated in the largely unregulated private sector, where quality of care is often poor. Private provider interface agencies (PPIAs) seek to improve private sector quality of care, which can be measured in terms of case fatality and recurrence rates. METHODS : We conducted a retrospective cohort survey of 4,000 private sector patients managed by the PATH PPIA between 2014 and 2017. We estimated treatment and post-treatment case-fatality ratios (CFRs) and recurrence rates. We used Cox proportional hazards models to identify predictors of fatality and recurrence. Patient loss to follow-up was adjusted for using selection weighting. RESULTS : The treatment CFR was 7.1% (95% CI 6.0-8.2). At 24 months post-treatment, the CFR was 2.4% (95% CI 1.7-3.0) and the recurrence rate was 1.9% (95% CI 1.3-2.5). Treatment fatality was associated with age (HR 1.02, 95% CI 1.02-1.03), clinical diagnosis (HR 0.61, 95% CI 0.45-0.84), treatment duration (HR 0.09, 95% CI 0.06-0.10) and adherence. Post-treatment fatality was associated with treatment duration (HR 0.87, 95% CI 0.79- 0.91) and adherence. CONCLUSIONS : We found a moderate treatment phase CFR among PPIA-managed private sector patient with low rates of post-treatment fatality and recurrence. Routine monitoring of patient outcomes after treatment would strengthen PPIAs and inform future post TB interventions.
UR - http://www.scopus.com/inward/record.url?scp=85113954339&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85113954339&partnerID=8YFLogxK
U2 - 10.5588/ijtld.21.0266
DO - 10.5588/ijtld.21.0266
M3 - Article
AN - SCOPUS:85113954339
SN - 1027-3719
VL - 25
SP - 738
JO - International Journal of Tuberculosis and Lung Disease
JF - International Journal of Tuberculosis and Lung Disease
IS - 9
ER -
