Abstract

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 South 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% CI, 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 LTFU 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.

• Keywords: Tuberculosis; Enhanced case management; Vulnerability assessment; Vulnerable population approach model; Community-based care