Lighthouse Trust, Lilongwe, Malawi.
Trop Med Int Health. 2012 Sep;17(9):1108-16. doi: 10.1111/j.1365-3156.2012.03041.x. Epub 2012 Jul 19.
To describe initial registration characteristics of adult and paediatric TB patients at a large, public, integrated TB and HIV clinic in Lilongwe, Malawi, between January 2008 and December 2010.
Routine data on patient with TB category and TB type, stratified by HIV and ART status, were used to explore differences in proportions among TB only, TB/HIV co-infected patients not on ART and TB/HIV co-infected patients on ART using chi-square tests. Trends over time illustrate strengths and weaknesses of integrated service provision.
Among 10 143 adults, HIV ascertainment and ART uptake were high and increased over time. The proportion of relapse was highest among those on ART (5%). The proportion of smear-positive pulmonary TB (PTB) was highest among HIV-negative patients with TB (34.9%); extra-pulmonary TB (EPTB) was lowest among TB only (16.2%). Among 338 children <15 years, EPTB and smear-positive PTB were more common among TB-only patients. Time trends showed significant increases in the proportion of adults with smear-positive PTB and the proportion of adults already on ART before starting TB treatment. However, some co-infected patients still delay ART initiation.
HIV ascertainment and ART uptake among co-infected patients are successful and improving over time. However, delays in ART initiation indicate some weakness linking TB/HIV patients into ART during TB follow-up care. Improved TB diagnostics and screening efforts, especially for paediatric patients, may help improve quality care for co-infected patients. These results may aid efforts to prioritise TB and HIV prevention, education and treatment campaigns for specific populations.
描述 2008 年 1 月至 2010 年 12 月期间，马拉维利隆圭一家大型综合性结核和艾滋病诊所成年和儿科结核患者的初始登记特征。
利用常规数据，按照 HIV 和抗逆转录病毒治疗（ART）状况，对结核患者进行分类，按照结核类型进行分层，采用卡方检验探讨仅患结核、未接受 ART 治疗的结核/艾滋病合并感染患者和接受 ART 治疗的结核/艾滋病合并感染患者之间的比例差异。随时间推移的趋势可说明综合服务提供的优势和不足。
在 10 143 名成年人中，HIV 检测和 ART 使用率较高且随时间推移而增加。接受 ART 治疗的患者中复发率最高（5%）。HIV 阴性且患有结核的患者中，痰涂片阳性肺结核（PTB）比例最高（34.9%）；仅患结核的患者中，肺外结核（EPTB）比例最低（16.2%）。在 338 名年龄<15 岁的儿童中，仅患结核的患者中更常见 EPTB 和痰涂片阳性 PTB。时间趋势表明，痰涂片阳性 PTB 患者和开始接受结核治疗前已接受 ART 治疗的成年患者比例显著增加。然而，一些合并感染患者仍延迟启动 ART。
HIV 合并感染患者的 HIV 检测和 ART 使用率成功且随时间推移而提高。然而，ART 启动延迟表明，在结核随访护理期间将结核/艾滋病患者纳入 ART 治疗方面存在一些不足。改善结核诊断和筛查工作，特别是针对儿科患者，可能有助于提高合并感染患者的护理质量。这些结果可能有助于为特定人群的结核和 HIV 预防、教育和治疗活动确定重点。
