The social determinants of tuberculosis and their association with TB/HIV co-infection in Lusaka, Zambia

Abstract

Introduction: Tuberculosis (TB) is a major public health problem globally.Progress made in TB control through the implementation of the DOTS strategy, has been retarded by factors such as poverty, the HIV pandemic and the advent of multidrug resistant tuberculosis. There is currently an increasing shift in TB control strategies to emphasize the importance of social determinants of TB if notable impact has to be attained. However, limited data exist that describe these determinants in high burden settings such as Zambia. This study was conducted to explore the social determinants of TB and their association with TB/HIV co-infection, in order to inform TB control strategies that would lead to appropriate action for impact.
Method: A cross-section study of TB patients presenting to four peri-urban health facilities in Lusaka through administration of a standard structured questionnaire. STATA 12 Version 1 was used for analysis.
Results: There were 1,259 TB patients enrolled. The median age was 35 (IQR; 29 – 41). The main determinants that were associated with TB/HIV co-infection were: being in the age-group 24-49 (p = 0.0001); being female (p = 0.0001); re-treatment (p = 0.0001); having extrapulmonary TB (p = 0.02); being married or widowed (p = 0.05 and p = 0.01, respectively)
Conclusions: Describing the social determinants of TB and their association with TB/HIV co-infection highlighted a number of opportunities to strengthen control beyond the Stop TB Strategy.