Das Mrinalini, Isaakidis Petros, Shenoy Rahul, Anicete Rey, Sharma Hemant Kumar, Ao Imyangluba, Osah Kaikho, Mansoor Homa, Saranchuk Peter, Abraham Sunita
Médecins Sans Frontières, Mon district, Nagaland, India.
District TB Control Office (RNTCP), Mon district, Nagaland, India.
PLoS One. 2014 Sep 26;9(9):e108186. doi: 10.1371/journal.pone.0108186. eCollection 2014.
Multiple strategies are being adopted by national tuberculosis (TB) programmes to achieve universal coverage of tuberculosis treatment. However, populations living in 'hard-to-reach' areas of north-east India have poor access to health services. Our study aimed to detail treatment outcomes in TB program supported by Médecins Sans Frontières (MSF) and using an alternative model of TB treatment delivery in Mon district, Nagaland, India.
This was a retrospective cohort study of TB patients, initiated on self-administered therapy (SAT) through Mon District Hospital, Nagaland, India between April 2012 and March 2013.
A total of 238 tuberculosis patients had final TB treatment outcomes during the study period, including 82 and 156 from semi-urban and rural areas respectively. The majority of patients (62%, 147/238) were suffering from pulmonary, smear-positive tuberculosis. Overall, 74% of patients (175/238) had successful outcomes, being cured or having completed their treatment. Females (81%), pulmonary TB patients (75%) and those on a Category I regimen (79%) had better treatment success rates than males (67%), extra-pulmonary TB patients (62%) and patients on a Category II regimen (61%). The univariate and bivariate analyses found age, sex and TB treatment regimen significantly associated with unsuccessful TB treatment outcomes (defined as death, loss-to-follow-up and failure). However, only older age showed significance in a multivariate binary logistic regression model.
Our study suggests that self-administered TB treatment is feasible for patients living in areas with limited or no access to health services. The relatively low number of patients with adverse outcomes suggests that SAT models are safe; other advantages include the need for fewer resources and less frequent movements by patients. National TB programmes should consider allowing SAT strategies for delivery of TB treatment to 'hard-to-reach' populations, which could in turn help to achieve universal coverage and contribute to global TB elimination by 2050.
各国结核病防治规划正在采取多种策略以实现结核病治疗的全面覆盖。然而，生活在印度东北部“难以抵达”地区的人群获得卫生服务的机会较差。我们的研究旨在详细阐述在印度那加兰邦蒙县由无国界医生组织（MSF）支持并采用替代结核病治疗模式的结核病防治项目中的治疗结果。
这是一项对结核病患者的回顾性队列研究，于2012年4月至2013年3月期间在印度那加兰邦通过蒙县医院启动自我管理治疗（SAT）。
在研究期间共有238例结核病患者获得了最终的结核病治疗结果，其中分别有82例和156例来自半城市和农村地区。大多数患者（62%，147/238）患有痰涂片阳性肺结核。总体而言，74%的患者（175/238）获得了成功结果，即治愈或完成了治疗。女性（81%）、肺结核患者（75%）和采用I类治疗方案的患者（79%）的治疗成功率高于男性（67%）、肺外结核患者（62%）和采用II类治疗方案的患者（61%）。单因素和双因素分析发现年龄、性别和结核病治疗方案与结核病治疗失败结果（定义为死亡、失访和治疗失败）显著相关。然而，在多因素二元逻辑回归模型中只有年龄较大显示出显著性。
我们的研究表明，自我管理的结核病治疗对于生活在卫生服务有限或无法获得卫生服务地区的患者是可行的。不良结果患者数量相对较少表明自我管理治疗模式是安全的；其他优点包括所需资源较少以及患者出行次数较少。各国结核病防治规划应考虑允许采用自我管理治疗策略为“难以抵达”人群提供结核病治疗，这反过来可能有助于实现全面覆盖并为到2050年全球消除结核病做出贡献。
