Fanai S, Viney K, Tarivonda L, Roseveare C, Tagaro M, Marais B J
National Tuberculosis Programme, Port Vila, Republic of Vanuatu.
Secretariat of the Pacific Community, Noumea, New Caledonia.
Public Health Action. 2014 Jun 21;4(Suppl 1):S19-24. doi: 10.5588/pha.13.0075.
National tuberculosis control programme, Vanuatu.
To assess tuberculosis (TB) trends, characterise sputum smear-positive patients with non-conversion at 2 months and assess their treatment outcomes.
Evaluation of programme data over a 9-year period (2004-2012), comparing 2-month sputum non-converters (delayed converters) with sputum smear converters diagnosed in 2011 and 2012.
Annual TB case numbers were similar over the study period, with an average TB notification rate of 58 per 100 000 population. Of 417 sputum smear-positive cases, 74 (18%) were delayed converters. Delayed converters were more likely than converters (88% vs. 79%) to have had high pre-treatment sputum smear grades (OR 2.5, 95%CI 0.97-6.45). Among delayed converters, treatment adherence was high (99% good adherence), outcomes were generally good (90% treatment success, 85% cure, 4% treatment failure) and no drug resistance was detected. Deaths were unexpectedly common among converters (11/80, 14%), with significantly more deaths in Tafea than in Shefa Province (7/58 vs. 2/80, OR 5.35, 95%CI 1.07-26.79). Tafea Province also had the greatest number of delayed converters (30/74, 40.5%) and the highest TB incidence rate.
Delayed sputum conversion was relatively uncommon, and was not associated with adverse outcomes or drug resistance. Regional differences require further investigation to better understand local factors that may compromise patient management.
瓦努阿图国家结核病控制项目。
评估结核病（TB）趋势，对2个月时痰涂片阳性未转阴患者进行特征分析，并评估其治疗结果。
对9年期间（2004 - 2012年）的项目数据进行评估，将2个月痰涂片未转阴者（延迟转阴者）与2011年和2012年诊断的痰涂片转阴者进行比较。
研究期间每年的结核病病例数相似，平均结核病报告率为每10万人口58例。在417例痰涂片阳性病例中，74例（18%）为延迟转阴者。延迟转阴者比转阴者更有可能在治疗前痰涂片分级较高（88%对79%，比值比2.5，95%置信区间0.97 - 6.45）。在延迟转阴者中，治疗依从性较高（99%依从性良好），结果总体良好（90%治疗成功，85%治愈，4%治疗失败），未检测到耐药情况。转阴者中死亡情况出人意料地常见（11/80，14%），塔菲亚省的死亡人数明显多于谢法省（7/58对2/80，比值比5.35，95%置信区间1.07 - 26.79）。塔菲亚省也是延迟转阴者数量最多的省份（30/74，40.5%），结核病发病率最高。
痰涂片延迟转阴相对不常见，且与不良结局或耐药无关。区域差异需要进一步调查，以更好地了解可能影响患者管理的当地因素。
