Factors Associated with Non-Adherence to Treatment Among Migrants with MDR-TB in Wuhan, China: A Cross-Sectional Study

Abstract

Background

Multidrug resistant tuberculosis (MDR-TB) has attracted increasing attention in achieving the global goal of tuberculosis (TB) control. China has the second largest TB burden worldwide and has been experiencing large-scale domestic migration. This study aims to explore the effect of migrants on non-adherence to MDR-TB treatment.

Materials and Methods

A cross-sectional study was carried out in Wuhan, China. The exposure cases were migrants who were not locally registered in the residence registration system. The control cases were local residents. Non-adherence cases were patients who were lost follow-up or refused treatment. Chi-square and t-test were used to compare variables between migrants and local residents. Logistic regression models using enter method were used to determine the relationship between migration and non-adherence to treatment. Moderation and medication effects on the association between migrant status and non-adherence were also explored.

Results

We studied 73 migrants and 219 local residents. The migrants, who did not to adhere to treatment (55, 75.3%), was far higher than that of local residents (89, 40.6%). Migrants with MDR-TB had 10.38-times higher difficulty in adhering to treatment (adjusted OR = 10.38, 95% CI 4.62–25.28) than local residents. This additional likelihood was moderated by age and treatment registration group. Migration had an indirect association with non-adherence to treatment via social medial insurance (adjusted OR = 1.05, 95% CI 1.01–1.13).

Conclusion

There a significant increased likelihood of non-adherence to treatment among migrants with MDR-TB, highlighting the importance of improving treatment adherence in this population. Migration prevented migrants from gaining access to social medical insurance and indirectly reduced their likelihood of adherence to treatment.

Keywords:

• MDR-TB
• migrant
• treatment adherence
• medical insurance
• out-of-pocket

Data Sharing Statement

The data-set used and analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The study design was approved by the ethics institutional review board of Huazhong University of Science and Technology, Wuhan, China (approval number: 20210630-S170). All the methods were carried out in accordance with relevant guidelines and regulations. The need for informed consent was waived by the ethics institutional review board of Huazhong University of Science and Technology because of the retrospective nature of the study. All authors confirm that this research caused no harm (physical or mental) to any participants. The research process complies with the Declaration of Helsinki. The health data was anonymously provided by Wuhan Pulmonary Hospital.

Acknowledgment

We thank Wuhan pulmonary hospital for providing historical data in the study, and those who reviewed drafts of this paper. We sincerely thank Xiao Liu, Yunfei Li, and Shanquan Chen for their contributions to our research manuscript in terms of data collection, methodological guidance, and writing assistance.

Disclosure

The authors declare that there were no competing interests.

Additional information

Funding

KL and LX were supported by National Natural Science Foundation of China (grant 72174068 and 71874058 to LX).