Ilangovan Kumaravel, Nagaraja Sharath Burugina, Ananthakrishnan Ramya, Jacob Anil G, Tripathy Jaya Prasad, Tamang Deepak
Health Systems Research India Initiative, Thirvananthapuram, India.
Department of Community Medicine, ESIC Medical College and PGIMSR, Bangalore, India.
PLoS One. 2015 Apr 30;10(4):e0125465. doi: 10.1371/journal.pone.0125465. eCollection 2015.
In India, the Revised National TB Control Programme (RNTCP) envisages initiation of TB treatment within seven days of diagnosis among smear-positive patients. After nearly two decades of RNTCP implementation, treatment delays are usually not expected.
To determine the proportion of sputum smear-positive TB patients who were initiated on treatment after seven days and their associated risk factors.
The study was conducted in Cuttack and Rayagada districts of Odisha. It was a retrospective cohort study that involves review of TB treatment registers and laboratory registers for 2013.
Among 1,800 pulmonary TB (PTB) patients, 1,074 (60%) had been initiated on treatment within seven days of diagnosis, 721 (40%) had been initiated on treatment more than seven days, and 354 (20%) had delays of more than 15 days. The mean duration between TB diagnosis and treatment initiation was 21 days with a range of 8-207 days (median = 14 days). Odds of treatment delay of more than seven days were 4.9 times (95% confidence interval [CI] 3.3-6.6) among those who had been previously treated, 6.2 times (95% CI 1.3-29.7) among those infected with HIV, and 1.8 times (95% CI 1.1-2.9) among those diagnosed outside district DMC.
Delay in initiation of TB treatment occurred in majority of the smear-positive patients. The RNTCP should focus on core areas of providing quality TB services with time-tested strategies. To have real-time monitoring mechanisms for diagnosed smear-positive TB patients is expected to be the way forward.
在印度，修订后的国家结核病控制规划（RNTCP）设想在涂片阳性患者诊断后7天内开始结核病治疗。在RNTCP实施近二十年后，通常不应出现治疗延迟情况。
确定在诊断7天后开始治疗的痰涂片阳性结核病患者比例及其相关危险因素。
该研究在奥里萨邦的库塔克和拉亚加达地区进行。这是一项回顾性队列研究，涉及查阅2013年的结核病治疗登记册和实验室登记册。
在1800例肺结核（PTB）患者中，1074例（60%）在诊断后7天内开始治疗，721例（40%）在诊断7天后开始治疗，354例（20%）延迟超过15天。结核病诊断与开始治疗之间的平均时长为21天，范围为8 - 207天（中位数 = 14天）。既往接受过治疗的患者治疗延迟超过7天的几率为4.9倍（95%置信区间[CI] 3.3 - 6.6），感染艾滋病毒的患者为6.2倍（95% CI 1.3 - 29.7），在地区疾病管理中心（DMC）以外诊断的患者为1.8倍（95% CI 1.1 - 2.9）。
大多数涂片阳性患者出现了结核病治疗延迟情况。RNTCP应专注于采用经过时间检验的策略提供优质结核病服务的核心领域。建立针对诊断出的涂片阳性结核病患者的实时监测机制有望成为前进方向。
