TB transmission is associated with prolonged stay in a low socio-economic, high burdened TB and HIV community in Cape Town, South Africa
Date
2020-02-10
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: While several studies have assessed the associations between biological factors and tuberculosis (TB)
transmission, our understanding of the associations between TB transmission and social and economic factors
remains incomplete. We aimed to explore associations between community TB transmission and socio-economic
factors within a high TB-HIV burdened setting.
Methods: We conducted a cross-sectional molecular epidemiology study among adult patients attending a routine
TB clinic. Demographic and clinical data were extracted from TB registers and clinical folders; social and economic
data were collected using interviewer-administered questionnaires; Mycobacterium tuberculosis isolates were
genotyped and classified as clustered/non-clustered using IS6110-based Restriction Fragment Length
Polymorphism. Composite “social” and “economic” scores were generated from social and economic data. Data
were analyzed using StataCorp version 15.0 software. Stratified, bivariable analyses were performed using chisquared.
Wilcoxon signed rank tests; univariable and multivariable logistic regression models were developed to
explore associations in the social, economic, traditional and composite TB risk factors with TB transmission.
Results: Of the 505 patient Mtb strains, 348(69%) cases were classified as clustered and 157(31%) were nonclustered.
Clustered cases were more likely to have lived longer in the study community, (odds ratio [OR] = 1.05,
95% Confidence interval [C.I]:1.02–1.09, p = 0.006); in the same house (OR = 1.04, C.I: 0.99–1.08, p = 0.06); and had
increased household crowding conditions (i.e fewer rooms used for sleeping, OR = 0.45, C.I:0.21–0.95, p = 0.04).
Although a higher proportion of clustered cases had a low economic score, no statistically significant association
was found between clustering and either the economic score (p = 0.13) or social score (p = 0.26).
Conclusions: We report a novel association between Mtb transmission and prolonged stay within a high burdened
community. Transmission was also associated with fewer rooms for sleeping in a household. Increased social
interaction and prolonged residence in a high burdened community are important factors linked to Mtb
transmission, possibly due to increased probability of higher effective contact rates. The possible importance of
degrees of poverty within low socio-economic setting warrants further study.
Description
CITATION: Tadokera, R., et al. 2020. TB transmission is associated with
prolonged stay in a low socio-economic, high burdened TB and HIV community in Cape Town, South Africa. BMC Infectious Diseases, 20:120, doi:10.1186/s12879-020-4828-z.
The original publication is available at https://bmcinfectdis.biomedcentral.com
The original publication is available at https://bmcinfectdis.biomedcentral.com
Keywords
Tuberculosis -- Transmission -- Cape Town (South Africa), Tuberculosis -- Transmission -- Developing countries, Tuberculosis -- Patients -- Cape Town (South Africa), HIV-positive persons -- Cape Town (South Africa)
Citation
Tadokera, R., et al. 2020. TB transmission is associated with
prolonged stay in a low socio-economic, high burdened TB and HIV community in Cape Town, South Africa. BMC Infectious Diseases, 20:120, doi:10.1186/s12879-020-4828-z