Virenfeldt J, Rudolf F, Camara C, Furtado A, Gomes V, Aaby P, Petersen E, Wejse C
Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Denmark.
Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
BMJ Open. 2014 Jun 10;4(6):e004818. doi: 10.1136/bmjopen-2014-004818.
To describe the risk factors for treatment delay and the effect of delay on the severity of tuberculosis (TB) in a prospectively followed TB cohort at the Bandim Health Project in Guinea-Bissau.
Treatment delay in patients with TB is associated with increased mortality and transmission of disease. However, it is not well described whether delay influences clinical severity at diagnosis. Previously reported risk factors for treatment delay vary in different geographical and cultural settings. Such information has never been investigated in our setting. Change in delay over time is rarely reported and our prospectively followed TB cohort gives an opportunity to present such data.
Patients were included at the time of diagnosis at three local TB clinics and the national TB reference hospital. Inclusion criteria were age >15 years and diagnosis of TB by either sputum examination or by the WHO clinical criteria. Patients with extrapulmonary TB were excluded.
The primary outcome was treatment delay. Delay was assessed by patient questionnaires. The secondary outcome was Bandim TBscore as a measure of TB morbidity and all-cause mortality.
A total of 1424 persons were diagnosed with TB in the study area between 2003 and 2010. We included 973 patients with TB in the study. The median treatment delay was 12.1 weeks. Risk factors for delay were low educational level, HIV-1+HIV-2 dual infection and negative sputum smear. TB treatment delay decreased by 10.3% (7.9-12.6%) per year during the study period. Delay was significantly associated with clinical severity at presentation with 20.8% severe TB cases in the low delay quartile compared with 33.9% if delay was over the median of 12.1 weeks.
Long treatment delay was associated with more severe clinical presentation. Treatment delay in TB cases is decreasing in Guinea-Bissau.
在几内亚比绍班迪姆健康项目前瞻性随访的结核病队列中，描述治疗延迟的风险因素以及延迟对结核病严重程度的影响。
结核病患者的治疗延迟与死亡率增加和疾病传播有关。然而，延迟是否会影响诊断时的临床严重程度尚未得到充分描述。先前报道的治疗延迟风险因素在不同的地理和文化背景中各不相同。在我们的研究环境中从未对此类信息进行过调查。很少有关于延迟随时间变化的报道，而我们前瞻性随访的结核病队列提供了呈现此类数据的机会。
在三个当地结核病诊所和国家结核病参考医院诊断时纳入患者。纳入标准为年龄>15岁，通过痰检或世界卫生组织临床标准诊断为结核病。排除肺外结核患者。
主要结局是治疗延迟。通过患者问卷评估延迟情况。次要结局是用班迪姆结核病评分作为结核病发病率和全因死亡率的衡量指标。
2003年至2010年期间，研究区域共有1424人被诊断为结核病。我们在研究中纳入了973例结核病患者。治疗延迟的中位数为12.1周。延迟的风险因素包括低教育水平、HIV-1+HIV-2双重感染和痰涂片阴性。在研究期间，结核病治疗延迟每年下降10.3%（7.9-12.6%）。延迟与就诊时的临床严重程度显著相关，延迟处于低四分位数时严重结核病病例占20.8%，而延迟超过12.1周中位数时这一比例为33.9%。
长时间治疗延迟与更严重的临床表现相关。在几内亚比绍，结核病病例的治疗延迟正在减少。
