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1 "Social vulnerability"
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Original Article
Vulnerability Assessment and Enhanced Community-based Care and Management of Patients With Tuberculosis in Korea: A Crossover Design
Jeongmi Seo, Dawoon Jeong, In-Hyuk Lee, Jiyeon Han, Yunhyung Kwon, Eunhye Shim, Hongjo Choi
J Prev Med Public Health. 2025;58(3):317-325.   Published online February 25, 2025
DOI: https://doi.org/10.3961/jpmph.24.597
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AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
People-centered care and social protection are critical for improving tuberculosis (TB) treatment outcomes. This study aimed to evaluate whether a vulnerability assessment tool, developed for an enhanced community-based care and management (ECCM) program in 2 Korean cities, could predict and improve final TB treatment outcomes based on patients’ vulnerability levels.
Methods
Treatment outcomes in the ECCM group were compared with those in a control group, stratified by vulnerability level. During stage 1, one city served as the intervention region and the other as the control, with a crossover in stage 2. The vulnerability assessment included all notified patients with TB, and those identified as highly vulnerable in the intervention group received social support following a consultation with a case manager.
Results
The vulnerability assessment tool demonstrated moderate predictive ability for unfavorable outcomes, with an area under the curve of 0.70 (95% confidence interval, 0.63 to 0.77). The patients with high vulnerability who received ECCM treatment demonstrated a 19.8-percentage point (%p) higher treatment success rate than the high vulnerability subcategory of the control group. ECCM also appeared to reduce loss to follow-up and TB-related mortality by 8.4%p and 7.3%p, respectively, although these findings should be interpreted with caution.
Conclusions
The results suggest that providing social support tailored to patient vulnerability at the time of diagnosis could improve TB treatment outcomes.
Summary
Korean summary
결핵 진단 시점의 임상적, 사회적, 그리고 결핵 관련 취약성 평가는 부정적인 치료 결과를 예측하는 데 유의미한 지표가 될 수 있다. 높은 취약성을 지닌 집단에 대해 지역사회 기반의 맞춤형 사례관리를 시행한 결과, 부정적 치료 결과를 일정 수준 감소시킬 수 있었다. 결핵의 사회적 결정요인과 노년 결핵환자 증가라는 역학적 상황은 지역사회 기반의 사회적 지원을 통해 개선 가능할 것이다.
Key Message
Clinical, social, and tuberculosis-related vulnerabilities assessed at the time of TB diagnosis can serve as meaningful predictors of unfavorable treatment outcomes. Community-based, ehnahced case management for highly vulnerable groups has been shown to reduce such negative outcomes to some extent. The social determinants of tuberculosis and the increasing prevalence of TB among the elderly may be addressed through community-based social support.

JPMPH : Journal of Preventive Medicine and Public Health
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