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Robsky KO, Isooba D, Nakasolya O, Mukiibi J, Nalutaaya A, Kitonsa PJ, Kamoga C, Baik Y, Kendall EA, Katamba A, Dowdy DW. Characterization of geographic mobility among participants in facility- and community-based tuberculosis case finding in urban Uganda. PLoS One 2021; 16:e0251806. [PMID: 33989343 PMCID: PMC8121348 DOI: 10.1371/journal.pone.0251806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background International and internal migration are recognized risk factors for tuberculosis (TB). Geographic mobility, including travel for work, education, or personal reasons, may also play a role in TB transmission, but this relationship is poorly defined. We aimed to define geographic mobility among participants in facility- and community-based TB case finding in Kampala, Uganda, and to assess associations between mobility, access to care, and TB disease. Methods We included consecutive individuals age ≥15 years diagnosed with TB disease through either routine health facility practices or community-based case finding (consisting of door-to-door testing, venue-based screening, and contact investigation). Each case was matched with one (for community-based enrollment) or two (health facility enrollment) TB-negative controls. We conducted a latent class analysis (LCA) of eight self-reported characteristics to identify and define mobility; we selected the best-fit model using Bayesian Information Criterion. We assessed associations between mobility and TB case status using multivariable conditional logistic regression. Results We enrolled 267 cases and 432 controls. Cases were more likely than controls to have been born in Kampala (p<0.001); there was no difference between cases and controls for remaining mobility characteristics. We selected a two-class LCA model; the “mobile” class was perfectly correlated with a single variable: travel (>3 km) from residence ≥2 times per month. Mobility was associated with a 28% reduction in odds of being a TB case (adjusted matched odds ratio 0.72 [95% confidence interval 0.49, 1.06]). Conclusion Frequency of out-of-neighborhood travel is an easily measured variable that correlates closely with predicted mobility class membership. Mobility was associated with decreased risk of TB disease; this may be in part due to the higher socioeconomic status of mobile individuals in this population. However, more research is needed to improve assessment of mobility and understand how mobility affects disease risk and transmission.
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Affiliation(s)
- Katherine O. Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- * E-mail:
| | - David Isooba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Olga Nakasolya
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - James Mukiibi
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Annet Nalutaaya
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Peter J. Kitonsa
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Caleb Kamoga
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Yeonsoo Baik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Emily A. Kendall
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Medicine, Clinical Epidemiology and Biostatistics Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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