Cherkaoui Imad, Sabouni Radia, Ghali Iraqi, Kizub Darya, Billioux Alexander C, Bennani Kenza, Bourkadi Jamal Eddine, Benmamoun Abderrahmane, Lahlou Ouafae, Aouad Rajae El, Dooley Kelly E
Directorate of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco.
National Institute of Hygiene, Ministry of Health, Rabat, Morocco.
PLoS One. 2014 Apr 3;9(4):e93574. doi: 10.1371/journal.pone.0093574. eCollection 2014.
Public tuberculosis (TB) clinics in urban Morocco.
Explore risk factors for TB treatment default and develop a prediction tool. Assess consequences of default, specifically risk for transmission or development of drug resistance.
Case-control study comparing patients who defaulted from TB treatment and patients who completed it using quantitative methods and open-ended questions. Results were interpreted in light of health professionals' perspectives from a parallel study. A predictive model and simple tool to identify patients at high risk of default were developed. Sputum from cases with pulmonary TB was collected for smear and drug susceptibility testing.
91 cases and 186 controls enrolled. Independent risk factors for default included current smoking, retreatment, work interference with adherence, daily directly observed therapy, side effects, quick symptom resolution, and not knowing one's treatment duration. Age >50 years, never smoking, and having friends who knew one's diagnosis were protective. A simple scoring tool incorporating these factors was 82.4% sensitive and 87.6% specific for predicting default in this population. Clinicians and patients described additional contributors to default and suggested locally-relevant intervention targets. Among 89 cases with pulmonary TB, 71% had sputum that was smear positive for TB. Drug resistance was rare.
The causes of default from TB treatment were explored through synthesis of qualitative and quantitative data from patients and health professionals. A scoring tool with high sensitivity and specificity to predict default was developed. Prospective evaluation of this tool coupled with targeted interventions based on our findings is warranted. Of note, the risk of TB transmission from patients who default treatment to others is likely to be high. The commonly-feared risk of drug resistance, though, may be low; a larger study is required to confirm these findings.
摩洛哥城市的公共结核病诊所。
探究结核病治疗中断的风险因素并开发一种预测工具。评估治疗中断的后果，特别是传播或产生耐药性的风险。
病例对照研究，采用定量方法和开放式问题比较结核病治疗中断的患者和完成治疗的患者。根据一项平行研究中卫生专业人员的观点对结果进行解读。开发了一种预测模型和一种识别高治疗中断风险患者的简易工具。收集肺结核患者的痰液进行涂片和药敏试验。
纳入91例病例和186例对照。治疗中断的独立风险因素包括当前吸烟、再次治疗、工作对依从性的干扰、每日直接观察治疗、副作用、症状迅速缓解以及不知道自己的治疗疗程。年龄>50岁、从不吸烟以及有知道自己诊断的朋友具有保护作用。纳入这些因素的一种简易评分工具在该人群中预测治疗中断的敏感性为82.4%，特异性为87.6%。临床医生和患者描述了导致治疗中断的其他因素，并提出了与当地相关的干预目标。在89例肺结核病例中，71%的患者痰液涂片结核阳性。耐药情况罕见。
通过综合患者和卫生专业人员的定性和定量数据，探究了结核病治疗中断的原因。开发了一种具有高敏感性和特异性的预测治疗中断的评分工具。有必要对该工具进行前瞻性评估，并根据我们的研究结果进行有针对性的干预。值得注意的是，治疗中断的患者将结核病传播给他人的风险可能很高。然而，人们普遍担心的耐药风险可能较低；需要更大规模的研究来证实这些发现。
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