Social and Clinical Factors Influencing Tb Treatment Outcomes in Labor Migrants

Abstract

Significance. A high level of coverage with preventive examinations of labor migrants arriving to work at enterprises in the Kaluga region makes it possible to detect tuberculosis (TB) at an early stage, which is characterized by an asymptomatic course, and with timely treatment it it possible to achieve its effective cure and thereby prevent the TB spread both among migrants and permanent population of the region. However, the majority of TB patients among labor migrant avoid treatment or interrupt the therapy due to lack of funds to pay for treatment. Undertreated patients continue to be sources of infection, often spreading resistant forms of tuberculosis with multidrug resistance of the pathogen. In addition, it is not possible to identify whereabouts of such patients, which fraught with TB spreading among the general population of the region. The purpose of the study: to analyze demographic and clinical factors influencing TB treatment outcomes in labor migrants. Material and methods. The study used information about 357 patients with tuberculosis, newly detected among the resident population of the Kaluga region, and 118 TB patients detected among labor migrants in 2019-2020. For the analysis, a questionnaire was developed, consisting of 9 demographic and clinical factors influencing outcomes of TB treatment. The analysis used information from the federal statistical surveillance forms No. 8 and No. 33 and Rosstat data on the average annual population of the Kaluga region in 2011-2020. To analyze TB treatment outcomes in labor migrants, data of the cohort analysis for 2016-2020 were used. Statistical analysis methods were used for the analysis. Results. In the Kaluga region in 2016-2020, 406 patients with tuberculosis were detected among 142,763 labor migrants examined by fluorography, or 0.3% of the total number. Analysis of a number of factors that affect TB treatment outcomes in labor migrants and the resident population of the Region in 2019-2020 showed that 90.7% of TB cases among labor migrants were detected at an early stage, which is asymptomatic, therefore in epidemic terms, they were much less dangerous compared to those detected among the resident population. However, only 123 patients were signed up for treatment, which accounted for 30.3% of the total number of TB patients among labor migrants, while the remaining 283 patients could not afford to pay for TB treatment and dropped off the TB service radar. Among patients with tuberculosis who started treatment, only 50% were effectively cured, while every third had to interrupt the treatment due to lack of funds to pay for the full course of chemotherapy. Conclusion. In order to reduce TB incidence among labor migrants and ensure free TB treatment in the Russian TB care facilities for labor migrants diagnosed with tuberculosis during their stay in Russia, there is an urgent need to find sources to finance costs associated with their treatment and to develop reimbursement mechanisms through introducing additions to legal documents on provision of medical care to labor migrants in those states where they have a permanent residency.