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SETTING: Although tuberculosis (TB) is a curable disease, it remains a major global health problem and an important cause of morbidity and mortality among vulnerable populations, including refugees and migrants. OBJECTIVE: To describe results and experiences over 20 years at a TB programme in refugee camps on the Thai-Burmese border in Tak Province, Thailand, and to identify risk factors associated with adverse outcomes (e.g., default, failure, death). DESIGN: Retrospective review of routine records of 2425 patients admitted for TB treatment in the Mae La TB programme between May 1987 and December 2005. RESULTS: TB cases notified among refugees decreased over 20 years. Among patients treated with a first-, second- or third-line regimen, 77.5% had a successful outcome, 13.5% defaulted, 7.6% died and 1.3% failed treatment. Multivariate analysis for new cases showed higher likelihood of adverse outcomes for patients who were Burmese migrants or Thai villagers, male, aged >15 years or with smear-negative pulmonary TB. CONCLUSION: These findings suggest that treatment outcomes depend on the programme's capacity to respond to specific patients' constraints. High-risk groups, such as migrant populations, need a patient-centred approach, and specific, innovative strategies have to be developed based on the needs of the most vulnerable and marginalised populations.

Type

Journal

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

Publication Date

12/2010

Volume

14

Pages

1589 - 1595

Addresses

Médecins Sans Frontières, Paris, France. andrea.minetti@epicentre.msf.org

Keywords

Sputum, Humans, Tuberculosis, Tuberculosis, Pulmonary, Antitubercular Agents, Treatment Outcome, Treatment Failure, Multivariate Analysis, Risk Factors, Retrospective Studies, Adolescent, Adult, Middle Aged, Child, Refugees, Transients and Migrants, Patient-Centered Care, Myanmar, Thailand, Female, Male, Young Adult