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Surveillance Open Access
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Abstract

Background

Previously a country with medium tuberculosis (TB) burden, Serbia almost reached a low TB burden during the period 2005 to 2015.

Aim

The aim of this study was to analyse the trends in notification rates and treatment success rates as well as to identify predictors of treatment outcomes.

Methods

We performed a trend analysis and logistic regression analysis of 17,441 TB cases registered from 2005 to 2015 in all health facilities in Serbia, to identify predictors of treatment success, loss to follow-up and mortality.

Results

From 2005 to 2015, TB notification rate and mortality in Serbia decreased but treatment success remained below the global target. Loss to follow-up was associated with retreatment (odds ratio (OR) = 2.38; 95% confidence interval (CI): 2.08–2.77), male sex (OR = 1.57; 95% CI: 1.39–1.79), age younger than 65 years (OR = 1.37; 95% CI: 1.20–1.51), lower education level (OR = 2.57; 95% CI: 1.74–3.80) and pulmonary TB (OR = 1.28; 95% CI: 1.06–1.56). Deaths were more frequent in retreatment cases (OR = 1.39; 95% CI: 1.12–1.61), male patients (OR = 1.34; 95% CI: 1.19–1.52), those 65 years and older (OR = 4.34; 95% CI: 4.00–5.00), those with lower education level (OR = 1.63; 95% CI: 1.14–2.33) and pulmonary TB (OR = 2.24; 95% CI: 1.78–2.83).

Conclusions

Special interventions should be implemented to address groups at risk of poor treatment outcome.

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/content/10.2807/1560-7917.ES.2020.25.1.1900322
2020-01-09
2024-04-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.1.1900322
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References

  1. World Health Organization (WHO). Global tuberculosis report 2018. Geneva: WHO; 2018. Available from: http://apps.who.int/medicinedocs/en/m/abstract/Js23553en/
  2. World Health Organization (WHO) and Stop TB Partnership. The Stop TB Strategy. Building on and enhancing DOTS to meet the TB-related millennium development goals. Geneva: WHO; 2006. Available from: https://www.who.int/tb/publications/tb-stoptb-strategy/en/
  3. World Health Organization (WHO). Implementing the end TB strategy: the essentials. Geneva: WHO; 2015. Available from: https://www.who.int/tb/publications/2015/The_Essentials_to_End_TB/en/
  4. Dangisso MH, Datiko DG, Lindtjørn B. Trends of tuberculosis case notification and treatment outcomes in the Sidama Zone, southern Ethiopia: ten-year retrospective trend analysis in urban-rural settings. PLoS One. 2014;9(12):e114225.  https://doi.org/10.1371/journal.pone.0114225  PMID: 25460363 
  5. European Centre for Disease Prevention and Control (ECDC). Tuberculosis surveillance and monitoring in Europe, 2017. Stockholm: ECDC, 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2017
  6. Smith CM, Trienekens SC, Anderson C, Lalor MK, Brown T, Story A, et al. Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014. Euro Surveill. 2017;22(8):30467.  https://doi.org/10.2807/1560-7917.ES.2017.22.8.30467  PMID: 28251890 
  7. Hudelson P. Gender differentials in tuberculosis: the role of socio-economic and cultural factors. Tuber Lung Dis. 1996;77(5):391-400.  https://doi.org/10.1016/S0962-8479(96)90110-0  PMID: 8959141 
  8. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60.  https://doi.org/10.1016/S0140-6736(12)61766-8  PMID: 23245609 
  9. Holmes CB, Hausler H, Nunn P. A review of sex differences in the epidemiology of tuberculosis. Int J Tuberc Lung Dis. 1998;2(2):96-104. PMID: 9562118 
  10. Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis. 2004;38(2):199-205.  https://doi.org/10.1086/380644  PMID: 14699451 
  11. World Health Organization (WHO). Definitions and reporting framework for tuberculosis – 2013 revision. Geneva: WHO; 2014. Available from: https://apps.who.int/iris/handle/10665/79199
  12. Vijay S, Kumar P, Chauhan LS, Vollepore BH, Kizhakkethil UP, Rao SG. Risk factors associated with default among new smear positive TB patients treated under DOTS in India. PLoS One. 2010;5(4):e10043.  https://doi.org/10.1371/journal.pone.0010043  PMID: 20386611 
  13. Pešut DP, Gledović ZB, Grgurević AD, Nagorni-Obradović LM, Adzić TN. Tuberculosis incidence in elderly in Serbia: key trends in socioeconomic transition. Croat Med J. 2008;49(6):807-12.  https://doi.org/10.3325/cmj.2008.49.807  PMID: 19090606 
  14. Jovanovic D, Skodric-Trifunovic V, Markovic-Denic L, Stevic R, Vlajinac H. Clinical and epidemiological evaluation of tuberculosis in Serbia, 1990-2004. Int J Tuberc Lung Dis. 2007;11(6):647-51. PMID: 17519096 
  15. Gledovic Z, Jovanovic M, Pekmezovic T. Tuberculosis trends in Central Serbia in the period 1956-1996. Int J Tuberc Lung Dis. 2000;4(1):32-5. PMID: 10654641 
  16. World Health Organization (WHO). Understanding and using tuberculosis data. Geneva: WHO; 2014. Available from: https://www.who.int/tb/publications/understanding_and_using_tb_data/en/
  17. Radosavljević-Asic G, Rebić P, Pavlović S, Kuruc V, Savić B, Jevtović Đ, et al. Revidirano stručno metodološko uputstvo za sprečavanje I suzbijanje tuberkuloze u Republici Srbiji. [Guidelines for tuberculosis management and control in the Republic of Serbia]. Belgrade: Ministry of Health of the Republic of Serbia; 2009. Serbian. Available from: http://www.batut.org.rs/download/izdvajamo/tuberkuloza/Revidirano%20Strucno-metodolosko%20uputstvo%20sprecavanje%20suzbijanje%20TB%20RS%202009.pdf
  18. Savić B, Vuković D, Dakić I, Aranđelović I. Vodič za mikrobiološku dijagnostiku tuberkuloze. [Guidelines for microbiological diagnostic of tuberculosis]. 3rd ed. Belgrade: Ministry of Health of the Republic of Serbia; 2015. Serbian. Available from: http://www.batut.org.rs/download/izdvajamo/tuberkuloza/Vodic%20za%20mikrobiolosku%20dijagnostiku%20TB.pdf
  19. Public Health Institute of Serbia. Izveštaj o kretanju zaraznih bolesti u Republici Srbiji u 2017. godini [Report on communicable diseases in the Republic of Serbia.] Belgrade; 2018. Serbian. Available from: http://www.batut.org.rs/download/izvestaji/Godisnji%20izvestaj%20zarazne%20bolesti%202017.pdf
  20. World Health Organization (WHO). Standards and benchmarks for tuberculosis surveillance and vital registration systems: checklist and user guide. Geneva: WHO; 2014. Available from: https://www.who.int/tb/publications/standardsandbenchmarks/en/
  21. Solovic I, Jonsson J, Korzeniewska-Koseła M, Chiotan DI, Pace-Asciak A, Slump E, et al. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. Euro Surveill. 2013;18(12):20432. PMID: 23557946 
  22. Stošić MB, Simić DM, Babić DD, Ristić L, Kuruc V. HIV prevalence, knowledge and self-perceived risk of HIV infection among tuberculosis patients in Serbia. Cent Eur J Public Health. 2019;27(2):99-105.  https://doi.org/10.21101/cejph.a4950  PMID: 31241283 
  23. Enos M, Sitienei J, Ong’ang’o J, Mungai B, Kamene M, Wambugu J, et al. Kenya tuberculosis prevalence survey 2016: Challenges and opportunities of ending TB in Kenya. PLoS One. 2018;13(12):e0209098.  https://doi.org/10.1371/journal.pone.0209098  PMID: 30586448 
  24. Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis. 2004;38(2):199-205.  https://doi.org/10.1086/380644  PMID: 14699451 
  25. Aït-Khaled N, Alarcón E, Armengol R, Bissell K, Boillot F, Caminero JA, et al. Management of tuberculosis: a guide to the essentials of good practice. Paris, France: International Union against Tuberculosis and Lung Disease, 2010. Available from: https://www.theunion.org/what-we-do/publications/technical/english/pub_orange-guide_eng.pdf
  26. Statistički godišnjak Republike Srbije. [Statistical yearbook of the Republic of Serbia]. Belgrade: Statistical Office of the Republic of Serbia; 2017. [Serbian]. Available from: https://publikacije.stat.gov.rs/G2017/PdfE/G20172022.pdf
  27. World Health Organization (WHO). Closing the gap: Policy into practice on social determinants of health. Discussion paper. World Conference on Determinants of Health; 19-21 Oct 2011; Rio de Janeiro, Brazil. Available from: https://www.who.int/sdhconference/Discussion-Paper-EN.pdf?ua=1
  28. de Colombani P, Hovhannesyan AWolfheze Working Group on Social Determinants of TB and Drug Resistant TB. Social determinants and risk factors for tuberculosis in national surveillance systems in Europe. Public Health Action. 2015;5(3):194-201.  https://doi.org/10.5588/pha.15.0026  PMID: 26399291 
  29. United Nations Programme on HIV/AIDS (UNAIDS). Global AIDS monitoring 2019. Indicators for monitoring the 2016 United Nations Political Declaration on Ending AIDS. Geneva: UNAIDS; 2018. Available from: https://www.unaids.org/sites/default/files/media_asset/global-aids-monitoring_en.pdf
  30. Nsagha DS, Pokam BT, Assob JC, Njunda AL, Kibu OD, Tanue EA, et al. HAART, DOTS and renal disease of patients co-infected with HIV/AIDS and TB in the South West Region of Cameroon. BMC Public Health. 2015;15(1):1040.  https://doi.org/10.1186/s12889-015-2331-z  PMID: 26452646 
  31. Chen J, Cao W, Chen R, Ren Y, Li T. Prevalence and determinants of HIV in tuberculosis patients in Wuxi City, Jiangsu province, China: a cross-sectional study. Int J STD AIDS. 2015;27(13):1204-12.  https://doi.org/10.1177/0956462415612618  PMID: 26482328 
  32. Dooley KE, Lahlou O, Ghali I, Knudsen J, Elmessaoudi MD, Cherkaoui I, et al. Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco. BMC Public Health. 2011;11(1):140.  https://doi.org/10.1186/1471-2458-11-140  PMID: 21356062 
  33. Millett ER, Noel D, Mangtani P, Abubakar I, Kruijshaar ME. Factors associated with being lost to follow-up before completing tuberculosis treatment: analysis of surveillance data. Epidemiol Infect. 2013;141(6):1223-31.  https://doi.org/10.1017/S095026881200163X  PMID: 22846385 
  34. Stosic M, Vukovic D, Babic D, Antonijevic G, Foley KL, Vujcic I, et al. Risk factors for multidrug-resistant tuberculosis among tuberculosis patients in Serbia: a case-control study. BMC Public Health. 2018;18(1):1114.  https://doi.org/10.1186/s12889-018-6021-5  PMID: 30208864 
  35. Karo B, Hauer B, Hollo V, van der Werf MJ, Fiebig L, Haas W. Tuberculosis treatment outcome in the European Union and European Economic Area: an analysis of surveillance data from 2002-2011. Euro Surveill. 2015;20(49):30087.  https://doi.org/10.2807/1560-7917.ES.2015.20.49.30087  PMID: 26676247 
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