Jakubowiak W M, Bogorodskaya E M, Borisov S E, Danilova I D, Kourbatova E V
WHO TB Control Programme in the Russian Federation, Office of the Special Representative of the WHO Director-General in Russia, 28, Ostozhenka St, 119034 Moscow, Russia.
Int J Tuberc Lung Dis. 2007 Jan;11(1):46-53.
Tuberculosis (TB) services in six Russian regions in which social support programmes for TB patients were implemented.
To identify risk factors for default and to evaluate possible impact of social support.
Retrospective study of new pulmonary smear-positive and smear-negative TB patients registered during the second and third quarters of the 2003. Data were analysed in a case-control study including default patients as cases and successfully treated patients as controls, using multivariate logistic regression modelling.
A total of 1805 cases of pulmonary TB were enrolled. Default rates in the regions were 2.3-6.3%. On multivariate analysis, risk factors independently associated with default outcome included: unemployment (OR 4.44; 95%CI 2.23-8.86), alcohol abuse (OR 1.99; 95%CI 1.04-3.81), and homelessness (OR 3.49; 95%CI 1.25-9.77). Social support reduced the default outcome (OR 0.13; 95%CI 0.06-0.28), controlling for age, sex, region, residence and acid-fast bacilli (AFB) smear of sputum.
Unemployment, alcohol abuse and homelessness were associated with increased default outcome among new TB patients, while social support for TB patients reduced default. Further prospective randomised studies are necessary to evaluate the impact and to determine the most cost-effective social support for improving treatment outcomes of TB in patients in Russia, especially among populations at risk of default.
俄罗斯六个地区实施了针对结核病患者的社会支持项目，本研究在这些地区开展结核病服务。
确定治疗中断的风险因素，并评估社会支持可能产生的影响。
对2003年第二和第三季度登记的新的痰涂片阳性和涂片阴性肺结核患者进行回顾性研究。在一项病例对照研究中对数据进行分析，将治疗中断患者作为病例，成功治疗患者作为对照，采用多因素逻辑回归模型。
共纳入1805例肺结核病例。各地区的治疗中断率为2.3%-6.3%。多因素分析显示，与治疗中断结局独立相关的风险因素包括：失业（比值比4.44；95%置信区间2.23-8.86）、酗酒（比值比1.99；95%置信区间1.04-3.81）和无家可归（比值比3.49；95%置信区间1.25-9.77）。在控制年龄、性别、地区、居住地和痰涂片抗酸杆菌检查结果后，社会支持降低了治疗中断结局（比值比0.13；95%置信区间0.06-0.28）。
失业、酗酒和无家可归与新结核病患者治疗中断结局增加相关，而对结核病患者的社会支持可降低治疗中断率。有必要开展进一步的前瞻性随机研究，以评估其影响，并确定最具成本效益的社会支持措施，以改善俄罗斯结核病患者的治疗结局，尤其是在有治疗中断风险的人群中。
