Household income and poor treatment outcome among patients with tuberculosis in Georgia: a cohort study.
BACKGROUND
Poverty is associated with increased risk of active tuberculosis (TB) disease onset, but the relation between household income and TB treatment outcomes is not well understood. The objective of this study was to determine household income characteristics associated with poor TB treatment outcome among newly diagnosed patients with pulmonary TB in the country of Georgia.


METHODS
A prospective cohort study was conducted among newly diagnosed smear positive pulmonary TB patients. Clinical and household data were collected from all consecutive patients seeking care at TB facilities in two major cities and one rural region in Georgia. Patients were followed prospectively during anti-TB regimens to determine treatment outcome. Bivariate analyses were used to determine the association of individual patient and household level characteristics with poor TB treatment outcome. A multivariable logistic model was used to estimate the adjusted association between patient household characteristics and poor TB treatment outcome.


RESULTS
After six months TB therapy, treatment outcome was available for 193 of 202 enrolled patients, of these 155 (80.3%) had a favorable TB treatment outcome. Compared to TB patients with poor treatment outcome, those with favorable treatment outcomes were younger (median 33.0 vs. 42.5 years), reported higher household monthly income (median $137 USD vs. $85 USD), were less likely to be unemployed (38.7 vs. 47.4%), and had higher level of education (38.7% vs. 31.6% with college education or greater). In multivariable analysis adjusted for age, sex, and socio-economic indicators, only low household income was remained statistically significantly associated with poor TB treatment outcome. Compared with patients from households with the highest tertile of monthly income, those in the middle tertile (aOR 4.28 95% CI 1.36, 13.53) and those in the lowest category of income (aOR 6.18 95% CI 1.83, 20.94) were significantly more likely to have poor treatment outcomes.


CONCLUSIONS
We demonstrated that TB patients in Georgia with lower household income were at greater risk of poor TB treatment outcomes. Providing targeted social assistance to TB patients and their households may improve clinical response to anti-TB therapy.
International School of Public Health, Tbilisi State Medical University, 33 Vazha-Pshavela Ave, 0177 Tbilisi, Georgia. mdjibuti@tsmu.edu.
Mamuka
M
Djibuti
Eka
E
Mirvelashvili
Nutsa
N
Makharashvili
Matthew J
MJ
Magee
D000328:Adult; D000367:Age Factors; D000995:Antitubercular Agents / Q000627:therapeutic use; D005191:Family Characteristics; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012959:Socioeconomic Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000191:economics*
D000995:Antitubercular Agents