Factors Associated With Tuberculosis Treatment Failure Among Hill Tribe and Stateless People in Chiang Rai Province, Thailand: A Case-Control Study.

BACKGROUND: Tuberculosis (TB) is a global public health challenge, especially for those who are living in economically disadvantaged families and have difficulty accessing health care services. The hill tribe and stateless people living in the border areas of northern Thailand have been identified as a population vulnerable to TB. This study aimed to determine the factors associated with tuberculosis treatment failure amongst hill tribe and stateless people in Chiang Rai, Thailand.

METHODS: A case-control study was performed to collect data from TB patients who were registered in one of 18 district hospitals in Chiang Rai Province, Thailand, between 2019 and 2023. The cases were hill tribe and stateless, with TB treatment failure, while the controls were TB successful treatment outcomes. A validated questionnaire was used to collect data between June and August 2024. Backward stepwise logistic regression was used to determine the factors that were significant at α = 0.05.

RESULTS: A total of 133 cases and 267 controls were included in the study: 56.5% were males, 41.8% were aged 61 years and older, 55.3% were Akha and Lahu members, 23.0% were nonThai, 73.8% had never attended school, 46.5% worked as farmers and 51.3% had an annual family income ≤ 10,000 baht ($332). In the multivariate model, eleven variables were found to be associated with tuberculosis treatment failure amongst the hill tribe and stateless TB patients: those who were females (AOR = 3.83; 95% CI = 1.77-8.29), those aged 61 years and over (AOR = 4.63; 95% CI = 1.62-13.23), those who were non-Thai citizens (AOR = 4.36; 95% CI = 1.74-10.87), those who had an annual family income of 5001-10,000 (AOR = 8.63; 95% CI = 2.55-29.18), those who had a family income of 10,001 baht and above (AOR = 4.28; 95% CI = 1.32-13.91), those who visited a TB clinic alone (AOR = 3.00; 95% CI = 1.33-6.78), those who ever missed a medical appointment (AOR = 21.06; 95% CI = 4.32-102.58), those who had side effects from TB medication (AOR = 7.88; 95% CI = 1.76-35.25), those who had a family member with TB (AOR = 2.80; 95% CI = 2.29-18.97), those who used traditional materials for their housing (AOR = 2.91; 95% CI = 1.76-4.80), those who experienced stress (AOR = 9.95; 95% CI = 2.85-34.80) and those who had little knowledge of TB prevention and control (AOR = 6.60; 95% CI = 2.81-16.57) had greater odds of having a TB treatment failure than those with opposite characteristics.

CONCLUSIONS: Hill tribe and stateless people who are female, are older, are non-Thai citizens, have missed appointments, have side effects from medication, are experiencing stress, used traditional materials for their housing and have poor knowledge of TB prevention and control are more likely to experience tuberculosis treatment failure. These findings strongly suggest that clinical staff who are working at TB clinics should focus on patients with these characteristics, including clinical guideline development to improve treatment success outcomes for these populations.