title: Identifying risk factors associated with smear positivity of pulmonary tuberculosis in Kazakhstan.
abstract: BACKGROUND
  Sputum smear-positive tuberculosis (TB) patients have a high risk of transmission and are of great epidemiological and infection control significance. Little is known about the smear-positive populations in high TB burden regions, such as Kazakhstan. The objective of this study is to characterize the smear-positive population in Kazakhstan and identify associated modifiable risk factors.
  
  
  METHODS
  Data on incident TB cases' (identified between April 2012 and March 2014) socio-demographic, risk behavior, and comorbidity characteristics were collected in four regions of Kazakhstan through structured survey and medical record review. We used multivariable logistic regression to determine factors associated with smear positivity.
  
  
  RESULTS
  Of the total sample, 193 (34.3%) of the 562 study participants tested smear-positive. In the final adjusted multivariable logistic regression model, sex (adjusted odds ratio (aOR) = 2.0, 95% CI:1.3-3.1, p < 0.01), incarceration (aOR = 3.6, 95% CI:1.2-11.1, p = 0.03), alcohol dependence (aOR = 2.6, 95% CI:1.2-5.7, p = 0.02), diabetes (aOR = 5.0, 95% CI:2.4-10.7, p < 0.01), and physician access (aOR = 2.7, 95% CI:1.3-5.5p < 0.01) were associated with smear-positivity.
  
  
  CONCLUSIONS
  Incarceration, alcohol dependence, diabetes, and physician access are associated with smear positivity among incident TB cases in Kazakhstan. To stem the TB epidemic, screening, treatment and prevention policies should address these factors.
authors.affiliation: Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America.
authors.forename: Sabrina
authors.identifier: http://orcid.org/0000-0002-4166-815X
authors.initials: S
authors.lastname: Hermosilla
authors.affiliation: Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: You
authors.affiliation: Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, United States of America.
authors.forename: Angela
authors.initials: A
authors.lastname: Aifah
authors.affiliation: National Center for Tuberculosis Problems, Almaty, Kazakhstan.
authors.forename: Tleukhan
authors.initials: T
authors.lastname: Abildayev
authors.affiliation: Center for Life Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, Republic of Kazakhstan.
authors.forename: Ainur
authors.initials: A
authors.lastname: Akilzhanova
authors.affiliation: Center for Life Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, Republic of Kazakhstan.
authors.forename: Ulan
authors.initials: U
authors.lastname: Kozhamkulov
authors.affiliation: National Association for TB Specialists, Almaty, Kazakhstan.
authors.forename: Talgat
authors.initials: T
authors.lastname: Muminov
authors.affiliation: Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan.
authors.forename: Meruert
authors.initials: M
authors.lastname: Darisheva
authors.affiliation: Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan.
authors.forename: Baurzhan
authors.initials: B
authors.lastname: Zhussupov
authors.affiliation: Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan.
authors.forename: Assel
authors.initials: A
authors.lastname: Terlikbayeva
authors.affiliation: Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, United States of America.
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.affiliation: Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America.
authors.forename: Neil
authors.initials: N
authors.lastname: Schluger
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D003581:Cytodiagnosis / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007623:Kazakhstan; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000473:pathology