Geographic Mobility and Treatment Outcomes among People in Care for Tuberculosis in the Lake Victoria Region of East Africa: A Multi-Site Prospective Cohort Study

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Citation

Mulholland, Grace E.; Herce, Michael E.; Bahemuka, Ubaldo M.; Kwena, Zachary A.; Jeremiah, Kidola; Okech, Brenda A.; Bukusi, Elizabeth A.; Okello, Elialilia S.; Nanyonjo, Gertrude; & Ssetaala, Ali, et al. (2023). Geographic Mobility and Treatment Outcomes among People in Care for Tuberculosis in the Lake Victoria Region of East Africa: A Multi-Site Prospective Cohort Study. PLOS Global Public Health, 3(6), e0001992. PMCID: PMC10241360

Abstract

Geographic mobility may disrupt continuity of care and contribute to poor clinical outcomes among people receiving treatment for tuberculosis (TB). This may occur especially where health services are not well coordinated across international borders, particularly in lower and middle income country settings. In this work, we describe mobility and the relationship between mobility and unfavorable TB treatment outcomes (i.e., death, loss to follow-up, or treatment failure) among a cohort of adults who initiated TB treatment at one of 12 health facilities near Lake Victoria. We abstracted data from health facility records for all 776 adults initiating TB treatment during a 6-month period at the selected facilities in Kenya, Tanzania, and Uganda. We interviewed 301 cohort members to assess overnight travel outside one's residential district/sub-county. In our analyses, we estimated the proportion of cohort members traveling in 2 and 6 months following initiation of TB treatment, explored correlates of mobility, and examined the association between mobility and an unfavorable TB treatment outcome. We estimated that 40.7% (95% CI: 33.3%, 49.6%) of people on treatment for TB traveled overnight at least once in the 6 months following treatment initiation. Mobility was more common among people who worked in the fishing industry and among those with extra-pulmonary TB. Mobility was not strongly associated with other characteristics examined, however, suggesting that efforts to improve TB care for mobile populations should be broad ranging. We found that in this cohort, people who were mobile were not at increased risk of an unfavorable TB treatment outcome. Findings from this study can help inform development and implementation of mobility-competent health services for people with TB in East Africa.

URL

http://dx.doi.org/10.1371/journal.pgph.0001992

Reference Type

Journal Article

Year Published

2023

Journal Title

PLOS Global Public Health

Author(s)

Mulholland, Grace E.
Herce, Michael E.
Bahemuka, Ubaldo M.
Kwena, Zachary A.
Jeremiah, Kidola
Okech, Brenda A.
Bukusi, Elizabeth A.
Okello, Elialilia S.
Nanyonjo, Gertrude
Ssetaala, Ali
Seeley, Janet
Emch, Michael
Pettifor, Audrey E.
Weir, Sharon S.
Edwards, Jessie K.

Article Type

Regular

PMCID

PMC10241360

Continent/Country

Uganda
Kenya
Tanzania

ORCiD

Emch - 0000-0003-2642-965X
Pettifor - 0000-0002-3387-0817
Weir - 0000-0001-6014-1460
Edwards, J -0000-0002-1741-335X