Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Setting
2.2.1. General Setting
2.2.2. Specific Setting
External Migrants:
|
2.3. Study Population
2.4. Data Sources, Collection, and Entry
2.5. Operational Definitions
- Migrants: Any patient for whom the risk factor “Internal migrant” or “External migrant” was entered into the treatment register were considered to be migrants, irrespective of whether they had any other concomitant risk factors.
- Successful treatment outcomes: If the treatment outcomes in the treatment were reported as “Cured” or “Treatment” and completed in the treatment register.
- Unsuccessful outcomes: If any of these outcomes is reported in the treatment register— “Treatment failure”, “Death”, “Loss to follow up”, or “Not evaluated”—treatment was deemed unsuccessful. Also, those patients for whom no treatment outcome was mentioned were considered not to have been evaluated and were, hence, categorized under “Unsuccessful outcomes”.
- Calculation of delays: Patient delay was the time between the onset of symptoms and the first visit to a health facility. Diagnostic delay was the time between first visit to a health facility and the confirmation of TB. Treatment delay was the time between diagnosis of TB and treatment initiation. Health system delay comprised of diagnostic delay and treatment delay [15].
2.6. Statistical Analysis
3. Results
3.1. Sociodemographic Characteristics of Migrants and Non-Migrants
3.2. Clinical Characteristics of Migrants and Non-Migrants
3.3. Patient, Diagnostic, and Treatment Delays for Migrants and Non-Migrants
3.4. Treatment Outcomes of Migrants and Non-Migrants
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Open Access Statement and Disclaimer
References
- The End TB Strategy. Available online: https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy (accessed on 29 October 2022).
- Human Mobility & Tuberculosis. Available online: https://www.iom.int/human-mobility-tuberculosis (accessed on 29 October 2022).
- International Standards for Tuberculosis Care (ISTC). Available online: https://www.who.int/publications/m/item/international-standards-for-tuberculosis-care-(istc) (accessed on 29 October 2022).
- Tilloeva, Z.; Aghabekyan, S.; Davtyan, K.; Goncharova, O.; Kabirov, O.; Pirmahmadzoda, B.; Rajabov, A.; Mirzoev, A.; Aslanyan, G. Tuberculosis in Key Populations in Tajikistan–a Snapshot in 2017. J. Infect. Dev. Ctries. 2020, 14, 94S–100S. [Google Scholar] [CrossRef] [PubMed]
- Huffman, S.A.; Veen, J.; Hennink, M.M.; McFarland, D.A. Exploitation, Vulnerability to Tuberculosis and Access to Treatment among Uzbek Labor Migrants in Kazakhstan. Soc. Sci. Med. 2012, 74, 864–872. [Google Scholar] [CrossRef] [PubMed]
- WHO. Releases New Global Lists of High-Burden Countries for TB, HIV-Associated TB and Drug-Resistant TB. Available online: https://www.who.int/news/item/17-06-2021-who-releases-new-global-lists-of-high-burden-countries-for-tb-hiv-associated-tb-and-drug-resistant-tb (accessed on 29 October 2022).
- World Food Programme; International Organization for Migration. Migration, Food Security and Nutrition in the Kyrgyz Republic. Available online: https://www.wfp.org/publications/migration-food-security-and-nutrition-kyrgyz-republic-december-2021 (accessed on 1 August 2023).
- Goncharova, O.; Denisiuk, O.; Zachariah, R.; Davtyan, K.; Nabirova, D.; Acosta, C.; Kadyrov, A. Tuberculosis among Migrants in Bishkek, the Capital of the Kyrgyz Republic. Public Health Action 2017, 7, 218–223. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kozhoyarova, A.; Sargsyan, A.; Goncharova, O.; Kadyrov, A. Who Is Doing Worse? Retrospective Cross-Sectional Study of TB Key Population Treatment Outcomes in Kyrgyzstan (2015–2017). J. Infect Dev. Ctries 2020, 14, 101S–108S. [Google Scholar] [CrossRef] [PubMed]
- Tuberculosis Treatment Success Rate (% of New Cases)-Kyrgyz Republic|Data. Available online: https://data.worldbank.org/indicator/SH.TBS.CURE.ZS?locations=KG (accessed on 4 November 2022).
- Isabekova, G. The Contribution of Vulnerability of Labour Migrants to Drug Resistance in the Region: Overview and Suggestions. Eur. J. Dev. Res. 2019, 31, 620–642. [Google Scholar] [CrossRef]
- International Organization for Migration. Kyrgyzstan: Study on the Socioeconomic Effects of COVID-19 on Returnees; IOM Kyrgyzstan: Bishkek, Kyrgyzstan, 2021; Available online: https://publications.iom.int/books/kyrgyzstan-study-socioeconomic-effects-covid-19-returnees (accessed on 1 August 2023).
- Population-Official Statistics-Statistics of the Kyrgyz Republic. Available online: http://www.stat.kg/en/statistics/naselenie/ (accessed on 2 November 2022).
- Kyrgyzstan Health System Review|United Nations in Kyrgyz Republic. Available online: https://kyrgyzstan.un.org/en/202524-kyrgyzstan-health-system-review (accessed on 8 May 2023).
- Sreeramareddy, C.T.; Qin, Z.Z.; Satyanarayana, S.; Subbaraman, R.; Pai, M. Delays in Diagnosis and Treatment of Pulmonary Tuberculosis in India: A Systematic Review. Int. J. Tuberc. Lung. Dis. 2014, 18, 255–266. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vandenbroucke, J.P.; von Elm, E.; Altman, D.G.; Gøtzsche, P.C.; Mulrow, C.D.; Pocock, S.J.; Poole, C.; Schlesselman, J.J.; Egger, M. STROBE Initiative Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med 2007, 4, e297. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization Regional Office for the Western Pacific. Tuberculosis Control in Migrant Populations: Guiding Principles and Proposed Actions; WHO: Geneva, Switzerland, 2016; ISBN 978-92-9061-775-4. [Google Scholar]
- Belkina, T.V.; Khojiev, D.S.; Tillyashaykhov, M.N.; Tigay, Z.N.; Kudenov, M.U.; Tebbens, J.D.; Vlcek, J. Delay in the Diagnosis and Treatment of Pulmonary Tuberculosis in Uzbekistan: A Cross-Sectional Study. BMC Infect. Dis. 2014, 14, 624. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ayé, R.; Wyss, K.; Abdualimova, H.; Saidaliev, S. Patient’s Site of First Access to Health System Influences Length of Delay for Tuberculosis Treatment in Tajikistan. BMC Health Serv. Res. 2010, 10, 10. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Meaza, A.; Tola, H.H.; Eshetu, K.; Mindaye, T.; Medhin, G.; Gumi, B. Tuberculosis among Refugees and Migrant Populations: Systematic Review. PLoS ONE 2022, 17, e0268696. [Google Scholar] [CrossRef] [PubMed]
- Turgunbayev, T.S.; Botoyeva, G.; Ablezova, M.; Tynayev, N.R. Conditions and State of Social Rehabilitation of Labor Migrants-Citizens of the Kyrgyz Republic Following Their Return to Homeland; Representative Office of RAST Foundation in Kyrgyzstan Social Research Center of American University in Central Asia: Bishkek, Kyrgyzstan, 2007. [Google Scholar]
- Zhdanova, E.; Goncharova, O.; Davtyan, H.; Alaverdyan, S.; Sargsyan, A.; Harries, A.D.; Maykanaev, B. 9–12 Months Short Treatment for Patients with MDR-TB Increases Treatment Success in Kyrgyzstan. J. Infect. Dev. Ctries. 2021, 15, 66S–74S. [Google Scholar] [CrossRef] [PubMed]
- Deya, R.W.; Masese, L.N.; Jaoko, W.; Muhwa, J.C.; Mbugua, L.; Horne, D.J.; Graham, S.M. Yield and Coverage of Active Case Finding Interventions for Tuberculosis Control: A Systematic Review and Meta-Analysis. Tuberc. Res. Treat. 2022, 2022, e9947068. [Google Scholar] [CrossRef]
- Park, S.; Sung, C.; Choi, H.; Lee, Y.W.; Kang, Y.; Kim, H.-J.; Kim, H.-Y.; Oh, I.-H.; Lee, S.H. Comparison of Active Tuberculosis Case Finding Strategies for Immigrants in South Korea: Epidemiology and Cost-Effectiveness Analysis. PLoS ONE 2023, 18, e0283414. [Google Scholar] [CrossRef] [PubMed]
Characteristic | Total (N = 5114) | Internal Migrants (N = 156) | External Migrants (N = 430) | Non-Migrants (N = 4528) | p-Value | |||
---|---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | |||
Age (in years) | <0.001 | |||||||
0–14 | 276 | 5 | (3.2) | 13 | (3.0) | 258 | (5.7) | |
15–29 | 1459 | 54 | (34.6) | 219 | (50.9) | 1186 | (26.2) | |
30–44 | 1160 | 49 | (31.4) | 113 | (26.3) | 998 | (22.0) | |
45–59 | 1099 | 26 | (16.7) | 66 | (15.4) | 1007 | (22.2) | |
60 and above | 1105 | 22 | (14.1) | 19 | (4.4) | 1064 | (23.5) | |
Not recorded | 15 | 0 | (0) | 0 | (0) | 15 | (0.3) | |
Gender | 0.061 | |||||||
Male | 2933 | 85 | (54.5) | 269 | (62.6) | 2579 | (56.9) | |
Female | 2181 | 71 | (45.5) | 161 | (37.4) | 1949 | (43.0) | |
Region of registration | <0.001 | |||||||
Chui | 1083 | 92 | (58.9) | 66 | (15.4) | 925 | (20.4) | |
Jalal-Abad | 971 | 4 | (2.6) | 83 | (19.3) | 884 | (19.5) | |
Osh region | 954 | 2 | (1.3) | 129 | (30.0) | 823 | (18.2) | |
Bishkek city | 921 | 43 | (27.6) | 33 | (7.7) | 845 | (18.6) | |
Osh city | 305 | 0 | (0) | 29 | (6.7) | 276 | (6.1) | |
Batken | 305 | 3 | (1.9) | 44 | (10.2) | 258 | (5.7) | |
Issykul | 222 | 2 | (1.3) | 29 | (6.7) | 191 | (4.2) | |
Naryn | 171 | 6 | (3.8) | 6 | (1.4) | 159 | (3.5) | |
Talas | 180 | 4 | (2.6) | 11 | (2.6) | 165 | (3.6) | |
Not recorded | 2 | 0 | (0) | 0 | (0) | 2 | (<1) | |
Citizenship | ||||||||
The Kyrgyz Republic | 5104 | 156 | (100) | 420 | (98) | 4528 | (100) | |
Other countries | 10 | 0 | (0) | 10 | (2) | 0 | (0) | |
Risk factors 1 | ||||||||
At least one risk factor | 2321 | 134 | (85.9) | 283 | (65.8) | 1904 | (42.1) | <0.001 |
Unemployed | 1731 | 114 | (73.1) | 246 | (57.2) | 1371 | (30.3) | <0.001 |
Smokers | 383 | 32 | (20.5) | 33 | (7.7) | 318 | (7.0) | <0.001 |
Alcohol users | 194 | 18 | (11.5) | 12 | (2.8) | 164 | (3.6) | <0.001 |
Homeless | 64 | 11 | (7.1) | 5 | (1.2) | 48 | (1.1) | <0.001 |
Ex-prisoners | 56 | 7 | (4.5) | 2 | (0.5) | 47 | (1.0) | <0.001 |
Health care workers | 21 | 1 | (0.6) | 2 | (0.5) | 18 | (0.4) | 0.881 |
Intravenous drug users | 13 | 0 | (0.0) | 2 | (0.5) | 11 | (0.2) | 0.556 |
Characteristic | Total (N = 5114) | Internal Migrants (N = 156) | External Migrants (N = 430) | Non-Migrants (N = 4528) | p-Value | |||
---|---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | |||
Type of facility at which diagnosis was established | <0.001 | |||||||
Polyclinic in same region 1 | 4114 | 132 | (84.6) | 400 | (93.0) | 3582 | (79.1) | |
Specialised TB facility in same region 1 | 996 | 24 | (15.4) | 30 | (6.9) | 942 | (20.8) | |
Not recorded | 4 | 0 | (0) | 0 | (0) | 4 | (0.1) | |
History of previous TB treatment | <0.001 | |||||||
New | 3637 | 118 | (75.6) | 355 | (82.5) | 3164 | (69.8) | |
Previously treated | 1080 | 36 | (23.1) | 68 | (15.8) | 976 | (21.5) | |
Not recorded | 397 | 2 | (1.3) | 7 | (1.6) | 388 | (8.6) | |
Site of TB | <0.001 | |||||||
Pulmonary | 3831 | 131 | (83.9) | 360 | (83.7) | 3340 | (73.8) | |
Extrapulmonary | 902 | 25 | (16.0) | 65 | (15.1) | 812 | (17.9) | |
Not recorded | 381 | 0 | (0.0) | 5 | (1.2) | 376 | (8.3) | |
Drug resistance | <0.001 | |||||||
Sensitive | 3652 | 97 | (62.1) | 301 | (70.0) | 3254 | (71.8) | |
Poly resistant | 262 | 17 | (10.9) | 29 | (6.7) | 216 | (4.8) | |
Rifampicin resistant | 242 | 8 | (5.1) | 36 | (8.4) | 198 | (4.4) | |
Multi drug resistant | 530 | 33 | (21.1) | 55 | (12.8) | 442 | (9.8) | |
Extensively drug resistant | 52 | 1 | (0.6) | 4 | (0.9) | 47 | (1.0) | |
Not recorded | 376 | 0 | (0) | 5 | (1.2) | 371 | (8.2) | |
HIV co-infection | <0.001 | |||||||
Present | 85 | 5 | (3.2) | 9 | (2.1) | 78 | (1.5) | |
Absent | 3320 | 123 | (78.9) | 333 | (77.4) | 3288 | (63.4) | |
Refused to be tested | 1709 | 28 | (17.9) | 88 | (20.5) | 1821 | (35.1) |
Stages | Internal Migrants (N=156) | External Migrants (N=430) | Non-Migrants (N=4528) | p-Value | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n (%) 1 | Median Days | (IQR) | n (%) 1 | Median Days | (IQR) | n (%) 1 | Median Days | (IQR) | ||||
Onset of symptoms to first contact with heath care provider (Patient delay) | 134 (86) | 21 | (9-56) | 391 (91) | 30 | (14-59) | 3985 (88) | 25 | (11-49) | 0.003 | ||
First contact with heath care provider to diagnosis of TB (Diagnostic delay) | 103 (66) | 6 | (3-14) | 275 (64) | 4 | (2-18) | 2712 (60) | 5 | (2-14) | 0.5 | ||
Diagnosis of TB to initiation of treatment (Treatment delay) | 84 (54) | 5 | (2-18) | 199 (46) | 4 | (1-13) | 1924 (42) | 4 | (2-14) | 0.5 | ||
Health system delay 2 | 145 (93) | 8 | (3-20) | 379 (88) | 6 | (2-20) | 3914 (86) | 7 | (3-20) | 0.28 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Istamov, K.; Beglaryan, M.; Goncharova, O.; Sakmamatov, K.; Kyrbashov, B.; Mamytova, M.; Zairova, I.; Alumkylova, G.; Nair, D. Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants? Trop. Med. Infect. Dis. 2023, 8, 412. https://doi.org/10.3390/tropicalmed8080412
Istamov K, Beglaryan M, Goncharova O, Sakmamatov K, Kyrbashov B, Mamytova M, Zairova I, Alumkylova G, Nair D. Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants? Tropical Medicine and Infectious Disease. 2023; 8(8):412. https://doi.org/10.3390/tropicalmed8080412
Chicago/Turabian StyleIstamov, Kylychbek, Mher Beglaryan, Olga Goncharova, Konushbek Sakmamatov, Bolot Kyrbashov, Mukadas Mamytova, Indira Zairova, Gulzat Alumkylova, and Divya Nair. 2023. "Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants?" Tropical Medicine and Infectious Disease 8, no. 8: 412. https://doi.org/10.3390/tropicalmed8080412
APA StyleIstamov, K., Beglaryan, M., Goncharova, O., Sakmamatov, K., Kyrbashov, B., Mamytova, M., Zairova, I., Alumkylova, G., & Nair, D. (2023). Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants? Tropical Medicine and Infectious Disease, 8(8), 412. https://doi.org/10.3390/tropicalmed8080412