蒙古国基于社区的直接观察下的抗结核治疗取得成功。

Success of community-based directly observed anti-tuberculosis treatment in Mongolia.

作者信息

Dobler C C, Korver S, Batbayar O, Oyuntsetseg S, Tsolmon B, Wright C, Solongo B, Marais B J

机构信息

National Health and Medical Research Council Centre of Research Excellence in Tuberculosis Control, University of Sydney, Sydney, Australia; Department of Respiratory Medicine, Liverpool Hospital and South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.

Mongolian National Tuberculosis Programme, National Centre for Communicable Diseases, Ulaanbaatar.

出版信息

Int J Tuberc Lung Dis. 2015 Jun;19(6):657-62. doi: 10.5588/ijtld.14.0927.

DOI:10.5588/ijtld.14.0927

PMID:25946355

Abstract

BACKGROUND

Many countries restrict access to directly observed therapy (DOT) for tuberculosis (TB) to government health facilities. More innovative approaches are required to reduce non-adherence, improve patient outcomes and limit the risk of selecting drug-resistant strains.

METHODS

We performed a retrospective cohort study in sputum smear-positive patients treated with community-based DOT (home-based DOT or 'lunch' DOT, whereby DOT is provided with a free daily meal once sputum smear conversion has been documented), and conventional clinic-based DOT in Ulaanbaatar, the capital of Mongolia, in 2010-2011. We compared treatment success using community-based home DOT vs. conventional clinic DOT and describe treatment completion rates using lunch DOT.

RESULTS

The overall treatment success among new sputum smear-positive TB patients was 85.1% (1505/1768). Patients receiving community DOT had higher cure rates (294/327, 89.9% vs. 1112/1441, 77.2%; aOR 2.66, 95%CI 1.81-3.90) and higher treatment success (306/327, 93.6% vs. 1199/1441, 83.2%; aOR 2.95, 95%CI 1.85-4.71, P < 0.001) than those treated with clinic DOT. Apart from one death, treatment completion was 100% among patients who received lunch DOT after sputum smear conversion.

CONCLUSIONS

Community DOT improved treatment success in Ulaanbaatar, Mongolia. It should now be scaled up to be made available for more patients and in all regions of the country.

摘要

背景

许多国家将结核病直接观察治疗（DOT）限制在政府卫生机构进行。需要更具创新性的方法来减少不依从性、改善患者治疗效果并限制产生耐药菌株的风险。

方法

2010年至2011年，我们在蒙古国首都乌兰巴托对痰涂片阳性患者进行了一项回顾性队列研究，这些患者接受基于社区的DOT（居家DOT或“午餐”DOT，即痰涂片转阴后每日提供一顿免费餐食的DOT）以及传统的基于诊所的DOT。我们比较了基于社区的居家DOT与传统诊所DOT的治疗成功率，并描述了“午餐”DOT的治疗完成率。

结果

新的痰涂片阳性结核病患者的总体治疗成功率为85.1%（1505/1768）。接受社区DOT的患者治愈率更高（294/327，89.9%对1112/1441，77.2%；调整后比值比2.66，95%置信区间1.81 - 3.90），治疗成功率也更高（306/327，93.6%对1199/1441，83.2%；调整后比值比2.95，95%置信区间1.85 - 4.71，P < 0.001）。除1例死亡外，痰涂片转阴后接受“午餐”DOT的患者治疗完成率为100%。