Salaniponi F M, Gausi F, Mphasa N, Nyirenda T E, Kwanjana J H, Harries A D
National Tuberculosis Control Programme, Community Health Science Unit, Lilongwe, Malawi.
Int J Tuberc Lung Dis. 2003 Sep;7(9 Suppl 1):S38-47.
Five districts in Malawi.
A new oral anti-tuberculosis treatment regimen with different directly observed treatment (DOT) choices in the initial phase of treatment was introduced for new patients in the five districts. The objectives were to determine 1) the site of DOT during the initial phase of treatment, and 2) the effectiveness of the new regimen.
Prospective data collection on all tuberculosis (TB) patients registered in a phased approach between 1 July 1997 and 31 December 1998, including site of DOT option in initial phase of treatment, 2-month and 8-month treatment outcomes, 2-month sputum smear conversion in smear-positive pulmonary tuberculosis (PTB) patients and in-patient hospital bed days.
There were 6335 new patients: 2671 (42%) with smear-positive PTB, 2211 (35%) with smear-negative PTB and 1453 (23%) with extra-pulmonary TB. The site of the initial phase of treatment was determined in 5790 patients: 1759 (30%) received DOT from guardians, 1465 (25%) from a health centre, 753 (13%) as out-patients from the hospital TB ward and 1813 (32%) remained in hospital. Eight-month treatment completion was 67% for smear-positive PTB patients, 51% for smear-negative PTB patients and 56% for extra-pulmonary TB patients. Two-month outcomes and 8-month treatment outcomes for all out-patient sites of supervision were satisfactory, except that a higher proportion of smear-positive PTB patients under guardian DOT failed to smear convert at 2 months. Over two-thirds of patients received ambulatory treatment out of hospital during the initial phase.
The new treatment strategy, tested in five districts, was associated with a reduction in hospital bed days and satisfactory treatment outcomes. The results of these studies were vital in helping the National TB Control Programme make an informed decision about phased expansion of the strategy countrywide.
马拉维的五个地区。
针对五个地区的新患者，引入一种在治疗初始阶段有不同直接观察治疗（DOT）选择的新型口服抗结核治疗方案。目的是确定：1）治疗初始阶段的DOT地点；2）新方案的有效性。
对1997年7月1日至1998年12月31日期间分阶段登记的所有结核病（TB）患者进行前瞻性数据收集，包括治疗初始阶段的DOT选择地点、2个月和8个月的治疗结果、涂片阳性肺结核（PTB）患者的2个月痰涂片转阴情况以及住院天数。
共有6335名新患者，其中涂片阳性PTB患者2671名（42%），涂片阴性PTB患者2211名（35%），肺外结核患者1453名（23%）。5790名患者确定了治疗初始阶段的地点，其中1759名（30%）由监护人进行DOT，1465名（25%）在卫生中心进行，753名（13%）作为门诊患者在医院结核病病房进行，1813名（32%）留在医院。涂片阳性PTB患者的8个月治疗完成率为67%，涂片阴性PTB患者为51%，肺外结核患者为56%。除了由监护人进行DOT的涂片阳性PTB患者中，有较高比例在2个月时痰涂片未转阴外，所有门诊监督地点的2个月结果和8个月治疗结果均令人满意。超过三分之二的患者在初始阶段接受了院外非卧床治疗。
在五个地区测试的新治疗策略，与住院天数减少和令人满意的治疗结果相关。这些研究结果对于帮助国家结核病控制规划就是否在全国分阶段扩大该策略做出明智决策至关重要。
