title: Tuberculosis-related knowledge is associated with patient outcomes in shantytown residents; results from a cohort study, Peru.
abstract: OBJECTIVE
  Tuberculosis is frequent among poor and marginalized people whose limited tuberculosis-related knowledge may impair healthcare access. We characterised tuberculosis-related knowledge and associations with delayed treatment and treatment outcome.
  
  
  METHODS
  Tuberculosis patients (n = 943), people being tested for suspected tuberculosis (n = 2020), and randomly selected healthy controls (n = 476) in 16 periurban shantytowns were interviewed characterizing: socio-demographic factors; tuberculosis risk-factors; and patients' treatment delay. Principle component analysis was used to generate a tuberculosis-related knowledge score. Patients were followed-up for median 7.7 years. Factors associated with tuberculosis treatment delay, treatment outcome and tuberculosis recurrence were assessed using linear, logistic and Cox regression.
  
  
  RESULTS
  Tuberculosis-related knowledge was poor, especially in older people who had not completed schooling and had never been diagnosed with tuberculosis. Tuberculosis treatment delay was median 60 days and was more delayed for patients who were poorer, older, had more severe tuberculosis and in only unadjusted analysis with incomplete schooling and low tuberculosis-related knowledge (all p ≤ 0.03). Lower than median tuberculosis-related knowledge was associated with tuberculosis recurrence (unadjusted hazard ratio = 2.1, p = 0.008), and this association was independent of co-morbidities, disease severity and demographic factors (multiple regression adjusted hazard ratio = 2.6, p = 0.008).
  
  
  CONCLUSIONS
  Low tuberculosis-related knowledge independently predicted tuberculosis recurrence. Thus health education may improve tuberculosis prognosis.
authors.affiliation: IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Emma E
authors.initials: EE
authors.lastname: Westerlund
authors.affiliation: IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benefica Prisma, Lima, Peru.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Tovar
authors.affiliation: Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Lönnermark
authors.affiliation: Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benefica Prisma, Lima, Peru.
authors.forename: Rosario
authors.initials: R
authors.lastname: Montoya
authors.affiliation: IFHAD: Innovation For Health And Development, Laboratory of Research and Development #218, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK. Electronic address: carlton.evans@ifhad.org.
authors.forename: Carlton A
authors.initials: CA
authors.lastname: Evans
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010568:Peru; D011203:Poverty; D025341:Principal Component Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy*; D055815:Young Adult
keywords: Clinical outcome; Mycobacterium tuberculosis; Recurrence; Tuberculosis knowledge