Jakubowiak W, Bogorodskaya E, Borisov S, Danilova I, Kourbatova E
WHO TB Control Programme in the Russian Federation, Office of the Special Representative of the World Health Organization Director-General in Russia, 28, Ostozhenka St., 119034 Moscow, Russian Federation.
Int J Infect Dis. 2009 May;13(3):362-8. doi: 10.1016/j.ijid.2008.07.015. Epub 2008 Nov 12.
To determine the frequency and length of treatment interruptions among new pulmonary tuberculosis (TB) patients and to evaluate the duration of interruption associated with default in the tuberculosis services of six Russian regions.
This was a retrospective study of all adult patients with new pulmonary TB enrolled for treatment from April 1 to September 30, 2003. Data from patients with treatment outcomes of default (n=84), failure (n=130), death (n=113), and success (n=1444) were analyzed.
The default rate was 4.6%. Treatment interruptions were frequent: 63% of patients who defaulted and 36% of those successfully treated had interruptions of treatment during the intensive phase, and 30% of those who defaulted and 45% of those with a successful outcome had interrupted treatment during the continuation phase. The length of treatment interruptions was 1-125 days during the intensive phase and 1-127 days during the continuation phase among patients with outcomes other than default. Patients with treatment gaps of 2-8 weeks during the intensive phase included 15.5% of defaulters, 13.9% of those with an outcome of failure, and 4.4% of those with treatment success. The integrated probability of default was >or=50% in those patients who missed at least 2-3 consecutive days of treatment during the intensive phase and at least one day during the continuation phase.
Treatment interruptions were frequent in TB patients in the six Russian regions. Interventions to improve treatment adherence in patients are necessary. Social support and incentive programs should be universally available for all patients from the start of the continuation phase of treatment, during the intensive phase for patients considered to be at risk for default, and for those patients who have missed at least 2-3 days of treatment during the intensive phase. Directly observed therapy (DOT) at home could be a recommendation for some patients.
确定新发肺结核患者治疗中断的频率和时长，并评估俄罗斯六个地区结核病服务中与治疗中断相关的持续时间。
这是一项对2003年4月1日至9月30日登记接受治疗的所有成年新发肺结核患者的回顾性研究。分析了治疗结果为中断治疗（n = 84）、治疗失败（n = 130）、死亡（n = 113）和治疗成功（n = 1444）的患者数据。
中断治疗率为4.6%。治疗中断很常见：63%的中断治疗患者和36%的治疗成功患者在强化期有治疗中断，30%的中断治疗患者和45%的治疗成功患者在继续期有治疗中断。在非中断治疗结果的患者中，强化期治疗中断时长为1 - 125天，继续期为1 - 127天。强化期治疗中断2 - 8周的患者包括15.5%的中断治疗者、13.9%的治疗失败患者和4.4%的治疗成功患者。在强化期至少连续漏服2 - 3天治疗且在继续期至少漏服1天的患者中，中断治疗的综合概率≥50%。
俄罗斯六个地区的肺结核患者治疗中断很常见。有必要采取干预措施提高患者的治疗依从性。从治疗继续期开始，应对所有患者普遍提供社会支持和激励计划，对有中断治疗风险的患者在强化期提供，对在强化期至少漏服2 - 3天治疗的患者也应提供。对一些患者可建议采用家庭直接督导下的治疗（DOT）。
