High levels of recurrent TB in the Philippines: results from a rural community cohort using a pragmatic design.

BACKGROUNDTB remains a major public health problem in the Philippines, which is among the 30 highest TB-burden countries. While treatment success rates are often used as indicators of programme performance, recurrence rates provide a more objective measure of long-term treatment effectiveness. Currently, the Philippines has limited data on recurrent TB.METHODSThis cohort from an active TB surveillance study in San Juan, Batangas (2013-2015), was followed up from March 2018 to January 2022. Recurrent TB, defined as an active TB case diagnosed and treated before with anti-TB drugs, was identified using national guidelines. Socio-demographic and clinical data were obtained from interviews and medical records. Incidence rates (per 1,000 person-years) and factors associated with recurrence were analysed using Cox proportional hazards models.RESULTSA total of 284 individuals were followed up for a median of 7.1 years, during which 71 participants (25%) developed recurrent TB, corresponding to an incidence rate of 38.3 cases per 1,000 person-years. Most recurrent cases were clinically diagnosed (87%) and occurred more than 2 years after the initial episode. Older age and lower socio-economic status were significantly associated with recurrence (P < 0.01).CONCLUSIONUsing pragmatic study design, we found TB recurrence is common in this high-burden setting..