Médecins Sans Frontières, Paris, France.
Int J Tuberc Lung Dis. 2010 Dec;14(12):1589-95.
Although tuberculosis (TB) is a curable disease, it remains a major global health problem and an important cause of morbidity and mortality among vulnerable populations, including refugees and migrants.
To describe results and experiences over 20 years at a TB programme in refugee camps on the Thai-Burmese border in Tak Province, Thailand, and to identify risk factors associated with adverse outcomes (e.g., default, failure, death).
Retrospective review of routine records of 2425 patients admitted for TB treatment in the Mae La TB programme between May 1987 and December 2005.
TB cases notified among refugees decreased over 20 years. Among patients treated with a first-, second- or third-line regimen, 77.5% had a successful outcome, 13.5% defaulted, 7.6% died and 1.3% failed treatment. Multivariate analysis for new cases showed higher likelihood of adverse outcomes for patients who were Burmese migrants or Thai villagers, male, aged >15 years or with smear-negative pulmonary TB.
These findings suggest that treatment outcomes depend on the programme's capacity to respond to specific patients' constraints. High-risk groups, such as migrant populations, need a patient-centred approach, and specific, innovative strategies have to be developed based on the needs of the most vulnerable and marginalised populations.
尽管结核病（TB）是一种可治愈的疾病，但它仍然是一个全球性的主要健康问题，也是弱势群体（包括难民和移民）发病率和死亡率的重要原因。
描述在泰国达府泰国-缅甸边境难民营的结核病方案 20 多年来的结果和经验，并确定与不良结局（如失访、失败、死亡）相关的风险因素。
对 1987 年 5 月至 2005 年 12 月期间在迈拉结核病方案中接受结核病治疗的 2425 名患者的常规记录进行回顾性审查。
20 年来，难民中报告的结核病病例有所减少。在接受一线、二线或三线方案治疗的患者中，77.5%的患者治疗结果成功，13.5%失访，7.6%死亡，1.3%治疗失败。对新发病例的多变量分析表明，对于缅甸移民或泰国村民、男性、年龄>15 岁或痰涂片阴性肺结核的患者，不良结局的可能性更高。
这些发现表明，治疗结果取决于方案应对特定患者限制的能力。高危人群，如移民群体，需要以患者为中心的方法，并且必须根据最脆弱和边缘化人群的需求制定具体的创新策略。
