TB outcomes and mortality risk factors in adult migrants at the Thailand-Myanmar border

BACKGROUND: Cross-border migrants at the Thailand-Myanmar border are an underserved and vulnerable population. We aimed to identify the causes and risk factors for TB mortality at a migrant-friendly TB programme. METHODS: Routinely collected data on TB cases, treatment outcomes and causes of death were analysed for adult TB cases diagnosed between January 2013 and April 2017. Mortality in the 6 months post-diagnosis was calculated and risk factors were identified using multivariable Poisson regression. RESULTS: Of the 1344 TB cases diagnosed, 1005 started treatment and 128 died. Case fatality rate was 9.5% and the TB mortality rate was 2.4/100 person-months. The number of pre-treatment deaths (33/128) and losses to follow-up (9.0%) were high. Among cases enrolled in treatment, the treatment success rate was 79.8%. When stratified by HIV status, case fatality was higher in HIV-positive cases not on antiretroviral therapy (ART) (90.3%) or with unknown HIV status (31.8%) than those on ART (14.3%) or HIV-negative (8.6%). CONCLUSION: This TB programme achieved high treatment success rates in a population with a substantial burden of TB-HIV coinfection. Expanding access to HIV testing and ART is crucial to reduce mortality. Striving towards same-day TB diagnosis and treatment could reduce death and loss to follow-up.