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乌干达三家地区医院结核病复治病例的特征及治疗结果

Characteristics and treatment outcomes of tuberculosis retreatment cases in three regional hospitals, Uganda.

作者信息

Nakanwagi-Mukwaya A, Reid A J, Fujiwara P I, Mugabe F, Kosgei R J, Tayler-Smith K, Kizito W, Joloba M

机构信息

International Union Against Tuberculosis and Lung Disease, Kampala, Uganda.

Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF Luxembourg, Luxembourg.

出版信息

Public Health Action. 2013 Jun 21;3(2):149-55. doi: 10.5588/pha.12.0105.

Abstract

SETTING

Three regional referral hospitals in Uganda with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) cases.

OBJECTIVE

To determine the treatment outcomes of TB retreatment cases and factors influencing these outcomes.

DESIGN

A retrospective cohort study of routinely collected National Tuberculosis Programme data between 1 January 2009 and 31 December 2010.

RESULTS

The study included 331 retreatment patients (68% males), with a median age of 36 years, 93 (28%) of whom were relapse smear-positive, 21 (6%) treatment after failure, 159 (48%) return after loss to follow-up, 26 (8%) relapse smear-negative and 32 (10%) relapse cases with no smear performed. Treatment success rates for all categories of retreatment cases ranged between 28% and 54%. Relapse smear-positive (P = 0.002) and treatment after failure (P = 0.038) cases were less likely to have a successful treatment outcome. Only 32% of the retreatment cases received a Category II treatment regimen; there was no difference in treatment success among patients who received Category II or Category I treatment regimens (P = 0.73).

CONCLUSION

Management of TB retreatment cases and treatment success for all categories in three referral hospitals in Uganda was poor. Relapse smear-positive or treatment after failure cases were less likely to have a successful treatment outcome.

摘要

背景

乌干达的三所地区转诊医院,结核病(TB)和人类免疫缺陷病毒(HIV)病例负担沉重。

目的

确定结核病复治病例的治疗结果以及影响这些结果的因素。

设计

一项回顾性队列研究,对2009年1月1日至2010年12月31日期间常规收集的国家结核病规划数据进行分析。

结果

该研究纳入了331例复治患者(68%为男性),中位年龄为36岁,其中93例(28%)为涂片阳性复发,21例(6%)为治疗失败后再治疗,159例(48%)为失访后返回,26例(8%)为涂片阴性复发,32例(10%)为未进行涂片检查的复发病例。各类复治病例的治疗成功率在28%至54%之间。涂片阳性复发(P = 0.002)和治疗失败后再治疗(P = 0.038)的病例治疗成功的可能性较小。只有32%的复治病例接受了II类治疗方案;接受II类或I类治疗方案的患者治疗成功率没有差异(P = 0.73)。

结论

乌干达三所转诊医院的结核病复治病例管理及各类病例的治疗成功率较差。涂片阳性复发或治疗失败后再治疗的病例治疗成功的可能性较小。

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