Investigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africa

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dc.contributor.advisorMiddelkoop, Kerenen_ZA
dc.contributor.advisorBekker, Linda-Gailen_ZA
dc.contributor.authorTadokera, Rabeccaen_ZA
dc.date.accessioned2018-05-25T07:47:09Z
dc.date.available2018-05-25T07:47:09Z
dc.date.issued2018en_ZA
dc.description.abstractBackground: While several studies have studied the associations between biological factors such as HIV-status with TB transmission or clustering, our understanding of the associations between TB transmission and socio-economic risk factors for TB remains incomplete. More studies are required to enhance our understanding, and hence inform targeted interventions to curb TB transmission, particularly in high burden communities. This study aimed to explore the associations between TB transmission and socio-economic risk factors in one such high TB and HIV burdened community. Methods: A cross-sectional molecular epidemiology study was conducted among adult TB patients resident in a geographically well-defined peri-urban township of Cape Town between 2001 and 2010. Following informed consent, clinical and demographic data were extracted from TB registers and clinical folders. Additional socio-economic data were collected using interviewer-administered questionnaires that were designed to capture data on TB history, TB contacts, socio-economic conditions such as occupation, income level, educational level, sexual behaviour, sexual history in addition to other social and demographic data. M.tb isolates from TB patients were previously analysed using IS6110-based RFLP. Strains with <6 copies of IS6110 (low bandwidth strains) are known to be poorly differentiated and so were excluded from analysis. Composite variables were generated for the social and economic factors using a scoring algorithm to create a "social score" and an "economic score". Data was analysed using StataCorp version 12 software. Bivariate associations and adjusted binary logistic regression analyses were performed to determine associations between TB transmission and the social/economic score in addition to other risk factors that were studied. Results: Of the 509 participants who had complete data available, 352 (69%) were classified as clustered while the remaining 157 participants (31%) were classified as non-clustered. Our analysis showed that clustered cases were more likely to have stayed for a longer period in the study community, (OR=1.06, C.I: 1.02 to 1.10, p=0.006). Clustered cases were also more likely to have stayed in the same house for longer, (median=3 years vs. 2 years, p=0.06) and to live in more crowded conditions as shown by the size of the house and number of rooms used for sleeping (p=0.038). While the evidence was weak, there was a tendency towards a positive association between a high social score and clustering (OR=1.39, C.I: 0.94; 2.03, p=0.08). Conversely, there was a moderate negative association between a high economic score and clustering (OR=0.69, C.I: 0.45; 1.06, p=0.09). Conclusions: While the association between poverty (poor socio-economic status) and TB transmission is not new, the association between TB transmission and prolonged stay within a high burdened community that we report in this study is novel. Our findings further suggest that even in poorer communities there is a "sliding-scale of poverty", with individuals at the lower end of the economic scale being at greater risk for acquiring TB infection and that targeted interventions to address TB transmission in such high burdened communities may be required.en_ZA
dc.identifier.apacitationTadokera, R. (2018). <i>Investigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africa</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/28146en_ZA
dc.identifier.chicagocitationTadokera, Rabecca. <i>"Investigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africa."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2018. http://hdl.handle.net/11427/28146en_ZA
dc.identifier.citationTadokera, R. 2018. Investigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africa. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Tadokera, Rabecca AB - Background: While several studies have studied the associations between biological factors such as HIV-status with TB transmission or clustering, our understanding of the associations between TB transmission and socio-economic risk factors for TB remains incomplete. More studies are required to enhance our understanding, and hence inform targeted interventions to curb TB transmission, particularly in high burden communities. This study aimed to explore the associations between TB transmission and socio-economic risk factors in one such high TB and HIV burdened community. Methods: A cross-sectional molecular epidemiology study was conducted among adult TB patients resident in a geographically well-defined peri-urban township of Cape Town between 2001 and 2010. Following informed consent, clinical and demographic data were extracted from TB registers and clinical folders. Additional socio-economic data were collected using interviewer-administered questionnaires that were designed to capture data on TB history, TB contacts, socio-economic conditions such as occupation, income level, educational level, sexual behaviour, sexual history in addition to other social and demographic data. M.tb isolates from TB patients were previously analysed using IS6110-based RFLP. Strains with <6 copies of IS6110 (low bandwidth strains) are known to be poorly differentiated and so were excluded from analysis. Composite variables were generated for the social and economic factors using a scoring algorithm to create a "social score" and an "economic score". Data was analysed using StataCorp version 12 software. Bivariate associations and adjusted binary logistic regression analyses were performed to determine associations between TB transmission and the social/economic score in addition to other risk factors that were studied. Results: Of the 509 participants who had complete data available, 352 (69%) were classified as clustered while the remaining 157 participants (31%) were classified as non-clustered. Our analysis showed that clustered cases were more likely to have stayed for a longer period in the study community, (OR=1.06, C.I: 1.02 to 1.10, p=0.006). Clustered cases were also more likely to have stayed in the same house for longer, (median=3 years vs. 2 years, p=0.06) and to live in more crowded conditions as shown by the size of the house and number of rooms used for sleeping (p=0.038). While the evidence was weak, there was a tendency towards a positive association between a high social score and clustering (OR=1.39, C.I: 0.94; 2.03, p=0.08). Conversely, there was a moderate negative association between a high economic score and clustering (OR=0.69, C.I: 0.45; 1.06, p=0.09). Conclusions: While the association between poverty (poor socio-economic status) and TB transmission is not new, the association between TB transmission and prolonged stay within a high burdened community that we report in this study is novel. Our findings further suggest that even in poorer communities there is a "sliding-scale of poverty", with individuals at the lower end of the economic scale being at greater risk for acquiring TB infection and that targeted interventions to address TB transmission in such high burdened communities may be required. DA - 2018 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Investigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africa TI - Investigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africa UR - http://hdl.handle.net/11427/28146 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/28146
dc.identifier.vancouvercitationTadokera R. Investigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africa. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2018 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/28146en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherPublic Healthen_ZA
dc.titleInvestigating the socio-economic and epidemiological risk factors associated with TB transmission in a high TB and HIV burdened community in Cape Town, South Africaen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPHen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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