Hlabisa Hospital, Hlabisa, KwaZulu-Natal, South Africa.
Int J Tuberc Lung Dis. 2010 Apr;14(4):420-6.
Hlabisa health sub-district, KwaZulu-Natal, South Africa.
To describe the establishment of a community-based multidrug-resistant tuberculosis (MDR-TB) treatment programme embedded in the district TB control programme and to evaluate whether early outcomes are comparable to those in the traditional hospital-based model of care.
Cases who initiated community-based MDR-TB treatment (CM) between March and December 2008 were compared with patients who initiated MDR-TB treatment under the traditional hospital-based model of care (TM) between January 2001 and February 2008. Time to initiation of treatment and time to sputum smear and culture conversion were compared for the two groups in Kaplan-Meier survival curves using the Mantel-Cox log-rank test.
Overall, 50 CM cases and 57 TM cases were included; 39 of the 50 CM cases (78.0%) were human immunodeficiency virus positive. The median time to initiation of treatment was 84 days for CM and 106.5 days for TM (P = 0.002). Median time to sputum smear conversion was shorter for CM than TM (59 vs. 92 days, P = 0.055), as was time to sputum culture conversion (85 vs. 119 days, P = 0.002).
Community-based treatment for MDR-TB can be implemented within the existing TB control programme in rural South Africa and should be scaled up where resources allow.
南非夸祖鲁-纳塔尔省赫拉布萨卫生分区。
描述在地区结核病控制规划中嵌入社区为基础的耐多药结核病（MDR-TB）治疗方案的建立，并评估早期结果是否与传统的医院为基础的护理模式相当。
2008 年 3 月至 12 月期间开始社区为基础的耐多药结核病（CM）治疗的病例与 2001 年 1 月至 2008 年 2 月期间开始传统医院为基础的耐多药结核病（TM）治疗的患者进行比较。在 Kaplan-Meier 生存曲线中，使用 Mantel-Cox 对数秩检验比较两组的治疗开始时间和痰涂片及培养转换时间。
共有 50 例 CM 病例和 57 例 TM 病例被纳入研究；50 例 CM 病例中有 39 例（78.0%）为人类免疫缺陷病毒阳性。CM 的中位治疗开始时间为 84 天，TM 的中位治疗开始时间为 106.5 天（P = 0.002）。CM 的痰涂片转换时间中位数短于 TM（59 天比 92 天，P = 0.055），痰培养转换时间中位数也短于 TM（85 天比 119 天，P = 0.002）。
在南非农村地区现有的结核病控制规划中，可以实施社区为基础的耐多药结核病治疗，在资源允许的情况下应予以扩大。
