Tuberculosis treatment in a refugee and migrant population: 20 years of experience on the Thai-Burmese border

• Published in: The international journal of tuberculosis and lung disease Vol. 14; no. 12; pp. 1589 - 1595
• Main Authors: MINETTI, A, CAMELIQUE, O, HSA THAW, K, THI, S, SWADDIWUDHIPONG, W, HEWISON, C, PINOGES, L, BONNET, M, GUERIN, P. J
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-12-2010; International Union against Tuberculosis and Lung Disease
• Subjects: Adolescent; Adult; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Child; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; migrants; Multivariate Analysis; Myanmar - ethnology; Mycobacterium; Patient-Centered Care - methods; Pneumology; Refugees; Refugees - statistics & numerical data; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Risk Factors; Sputum - microbiology; Thailand; Thailand - epidemiology; Transients and Migrants - statistics & numerical data; Treatment Failure; Treatment Outcome; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - ethnology; Tuberculosis and atypical mycobacterial infections; Tuberculosis Treatment; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - ethnology; Young Adult; Thailand; Asia; Myanmar; refugees; Respiratory disease; tuberculosis treatment; Refugee; Mycobacterial infection; Thailand; Infection; Treatment; Tuberculosis; migrants; Bacteriosis; Population; Pneumology
• ISSN: 1027-3719; 1815-7920

SETTING: Although tuberculosis (TB) is a curable disease, it remains a major global health problem and an important cause of morbidity and mortality among vulnerable populations, including refugees and migrants.OBJECTIVE: To describe results and experiences over 20 years at a TB
programme in refugee camps on the Thai-Burmese border in Tak Province, Thailand, and to identify risk factors associated with adverse outcomes (e.g., default, failure, death).DESIGN: Retrospective review of routine records of 2425 patients admitted for TB treatment in the Mae La TB programme
between May 1987 and December 2005.RESULTS: TB cases notified among refugees decreased over 20 years. Among patients treated with a first-, second- or third-line regimen, 77.5% had a successful outcome, 13.5% defaulted, 7.6% died and 1.3% failed treatment. Multivariate analysis for new
cases showed higher likelihood of adverse outcomes for patients who were Burmese migrants or Thai villagers, male, aged >15 years or with smear-negative pulmonary TB.CONCLUSION: These findings suggest that treatment outcomes depend on the programme's capacity to respond to specific
patients' constraints. High-risk groups, such as migrant populations, need a patient-centred approach, and specific, innovative strategies have to be developed based on the needs of the most vulnerable and marginalised populations.