{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:08:11Z","timestamp":1792786091115,"version":"4.5.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordination for the Improvement of Higher Education Personnel of Brazil","doi-asserted-by":"publisher","award":["001"],"award-info":[{"award-number":["001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Santander International Mobility Program","award":["1939"],"award-info":[{"award-number":["1939"]}]},{"name":"Columbia University\u2013Southern African Fogarty AIDS International Training and Research Program"},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI124413-01"],"award-info":[{"award-number":["R01AI124413-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CAPRISA","id":[{"id":"https:\/\/ror.org\/04qkg4668","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001713","name":"EDCTP","doi-asserted-by":"publisher","award":["TMA2018SF-2467"],"award-info":[{"award-number":["TMA2018SF-2467"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European and Developing Countries Clinical Trials Partnership Programme","award":["RIA2019IR-288"],"award-info":[{"award-number":["RIA2019IR-288"]}],"id":[{"id":"https:\/\/ror.org\/031jv9v19","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rifampicin-resistant tuberculosis (RR-TB) remains a major public health challenge in TB-endemic regions. While social determinants of health affect infectious disease outcomes, their impact on RR-TB remains poorly understood. This study evaluated the relationship between educational attainment, social disadvantage, and RR-TB outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using data from 4 Centre for the AIDS Programme of Research in South Africa RR-TB clinical trials. Social vulnerability was measured using an exploratory Social Disadvantage Score (SDS) that incorporated education, employment, and incarceration. We used a latent class analysis (LCA) to identify classes with shared social vulnerability indicators. Associations with treatment outcomes were assessed using Cox regression models, with the exploratory SDS, its component indicators, and derived latent classes as predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Education was not independently associated with unfavorable treatment outcomes (adjusted hazard ratio [aHR] = 1.39, 95% confidence interval [CI]: 0.96\u20131.99, P = .077), whereas a history of incarceration doubled the hazard (aHR = 2.05, 95% CI: 1.33\u20133.16, P &amp;lt; .001). Restricting subsequent models to the subcohort with collected employment data, unemployment increased the hazard of unfavorable outcomes (aHR = 1.84, 95% CI: 1.20\u20132.82, P = .005). Using the same subcohort, increasing cumulative social disadvantage showed a strong dose\u2013response relationship, with a 5-fold higher hazard for 3 disadvantages (aHR = 5.85, 95% CI: 2.73\u201312.56, P &amp;lt; .001). Latent class analysis revealed that Class 2 (moderate socioeconomic advantage) had a significantly higher hazard of unfavorable outcomes (aHR = 1.82, 95% CI: 1.19\u20132.79, P = .006).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cumulative social risk score was associated with unfavorable RR-TB outcomes, supporting further evaluation of targeted support for disadvantaged populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag531","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T11:50:35Z","timestamp":1787140235000},"source":"Crossref","is-referenced-by-count":0,"title":["A Retrospective Analysis Examining the Impact of Educational Attainment and Social Determinants of Health on Rifampicin-Resistant Tuberculosis Treatment Outcomes"],"prefix":"10.1093","volume":"13","author":[{"given":"Titilade Kehinde Ayandeyi","family":"Teibo","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Nursing and Public Health, University of S\u00e3o Paulo, College of Nursing at Ribeir\u00e3o Preto , Ribeir\u00e3o Preto, S\u00e3o Paulo ,","place":["Brazil"]},{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8892-2904","authenticated-orcid":false,"given":"Rubeshan","family":"Perumal","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"University of KwaZulu-Natal Department of Pulmonology and Critical Care, Nelson R Mandela School of Medicine, College of Health Sciences, , Durban, KwaZulu-Natal ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lateef Babatunde","family":"Amusa","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"Department of Statistics, University of Ilorin , Ilorin ,","place":["Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Letitia","family":"Shunmugam","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nonkululeko","family":"Mzinyane","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darshan","family":"Chetty","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Resha","family":"Boodhram","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radhamoney","family":"Narasimmulu","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takondwa","family":"Kachoka","sequence":"additional","affiliation":[{"name":"Clinical HIV Research Unit (CHRU), Jose Pearson TB Hospital, Wits Health Consortium Pty Ltd , Port Elizabeth ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Shozi","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max R","family":"O\u2019Donnell","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Wolf","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunitha","family":"Chotoo","sequence":"additional","affiliation":[{"name":"King Dinuzulu Hospital Complex Drug-resistant Tuberculosis Unit, , Sydenham, Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalini","family":"Singh","sequence":"additional","affiliation":[{"name":"King Dinuzulu Hospital Complex Drug-resistant Tuberculosis Unit, , Sydenham, Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Alexandre","family":"Arc\u00eancio","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Nursing and Public Health, University of S\u00e3o Paulo, College of Nursing at Ribeir\u00e3o Preto , Ribeir\u00e3o Preto, S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesri","family":"Padayatchi","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban ,","place":["South Africa"]},{"name":"CAPRISA-SAMRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8874-6661","authenticated-orcid":false,"given":"Kogieleum","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal , Durban 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