Heunis J C, Kigozi N G, van der Merwe S, Chikobvu P, Beyers N
Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa.
Free State Department of Health, Bloemfontein, South Africa.
Public Health Action. 2014 Mar 21;4(1):66-71. doi: 10.5588/pha.13.0108.
Free State Province, South Africa.
To examine sex-specific trends in 2-month sputum smear non-conversion in new sputum smear-positive tuberculosis (TB) cases during a period when the DOTS strategy was operative.
A retrospective cohort study of TB cases registered between 2003 and 2009 was conducted. Non-conversion was indicated by a positive 2-month sputum smear result. Descriptive and generalised linear model analyses were performed and sex-specific trends in 2-month sputum smear non-conversion rates estimated.
Overall, 2-month sputum smear non-conversion rates were 12.5% in males and 9.3% in females. Non-conversion was significantly associated with age in males (P < 0.001). Non-conversion rates declined significantly between 2003 and 2009: from 15.9% to 10.8% in males (P < 0.001) and from 12.0% to 6.6% in females (P < 0.001). The average rate of decline of non-conversion was higher among females (1.0%, 95%CI 0.8-1.2) than among males (0.8%, 95%CI 0.5-1.0). By 2009, males had a 60% higher risk of non-conversion than females (RR 1.60, CI 1.37-1.86).
The decline in the trend of 2-month sputum smear non-conversion confirms the relative success of the DOTS strategy in TB control, with better performance among females than males. Interventions should consider the sex and age of patients to improve the 2-month sputum smear-conversion rate.
南非自由邦省。
在直接观察短程治疗（DOTS）策略实施期间，研究新诊断的痰涂片阳性肺结核（TB）病例中2个月痰涂片仍未转阴的性别差异趋势。
对2003年至2009年登记的TB病例进行回顾性队列研究。2个月痰涂片仍为阳性表明未转阴。进行描述性和广义线性模型分析，并估计2个月痰涂片未转阴率的性别差异趋势。
总体而言，男性2个月痰涂片未转阴率为12.5%，女性为9.3%。男性未转阴与年龄显著相关（P < 0.001）。2003年至2009年期间，未转阴率显著下降：男性从15.9%降至10.8%（P < 0.001），女性从12.0%降至6.6%（P < 0.001）。女性未转阴率的平均下降速度（1.0%，95%CI 0.8 - 1.2）高于男性（0.8%，95%CI 0.5 - 1.0）。到2009年，男性未转阴的风险比女性高60%（RR 1.60，CI 1.37 - 1.86）。
2个月痰涂片未转阴趋势的下降证实了DOTS策略在结核病控制方面取得了相对成功，女性的表现优于男性。干预措施应考虑患者的性别和年龄，以提高2个月痰涂片转阴率。
