Kigozi G, Heunis C, Chikobvu P, Botha S, van Rensburg D
Centre for Health Systems Research & Development, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa.
Centre for Health Systems Research & Development, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa.
Int J Infect Dis. 2017 Jan;54:95-102. doi: 10.1016/j.ijid.2016.11.407. Epub 2016 Nov 25.
To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa.
A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05.
A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p<0.001), <25 years old (9.1% vs. 25-34 years: 8.7%; 35-44 years: 7.0%; 45-54 years: 5.2%; 55-64 years: 4.4%; >64 years: 3.9%; p<0.001), undergoing TB retreatment (11.0% vs. new cases: 6.3%; p<0.001), had a negative pre-treatment sputum smear result (7.8% vs. positive smear results: 7.1%; p<0.001), were in the first 2 months of treatment (95.5% vs. >2 months: 4.8%; p<0.001), and had unknown HIV status (7.8% vs. HIV-positive: 7.0% and HIV-negative: 5.7%; p<0.001). After controlling for potential confounders, multivariate analysis revealed a two-fold increased risk of defaulting treatment when being retreated compared to being treated for the first time for TB (adjusted OR (AOR) 2.0, 95% CI 1.85-2.25). Female cases were 40% less likely to default treatment compared to their male counterparts (AOR 0.6, 95% CI 0.51-0.71). Treatment default was less likely among cases >24 years old compared to younger cases (25-34 years: AOR 0.8, 95% CI 0.77-0.87; 35-44 years: AOR 0.6, 95% CI 0.50-0.64; 45-54 years: AOR 0.4, 95% CI 0.32-0.49; 55-64 years: AOR 0.3, 95% CI 0.21-0.43; >64 years: AOR 0.3, 95% CI 0.19-0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46-0.57).
Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes.
确定并描述影响南非自由邦省结核病（TB）患者治疗中断的因素。
对2003年至2012年期间录入ETR.Net电子结核病登记册的肺结核病例进行回顾性记录审查。研究对象年龄大于15岁且有治疗前涂片结果记录。描述了治疗中断者的人口统计学和临床特征。采用多因素logistic回归分析确定与治疗中断相关的因素。估计比值比（OR）及其相应的95%置信区间（CI）。以0.05为统计学显著性水平。
110349例病例中共有7980例（7.2%）治疗中断。男性病例比例显著更高（8.3%对比女性：5.8%；p<0.001），年龄小于25岁（9.1%对比25 - 34岁：8.7%；35 - 44岁：7.0%；45 - 54岁：5.2%；55 - 64岁：4.4%；64岁以上：3.9%；p<0.001），正在接受结核病复治（11.0%对比新发病例：6.3%；p<0.001），治疗前痰涂片结果为阴性（7.8%对比涂片阳性结果：7.1%；p<0.001），处于治疗的前2个月（95.5%对比大于2个月：4.8%；p<0.001），且HIV状态未知（7.8%对比HIV阳性：7.0%和HIV阴性：5.7%；p<0.001）。在控制潜在混杂因素后，多因素分析显示，与首次接受结核病治疗相比，复治时治疗中断风险增加两倍（调整后OR（AOR）2.0，95%CI 1.85 - 2.25）。女性病例治疗中断的可能性比男性低40%（AOR 0.6，95%CI 0.51 - 0.71）。与年轻病例相比，24岁以上病例治疗中断的可能性较小（25 - 34岁：AOR 0.8，95%CI 0.77 - 0.87；35 - 44岁：AOR 0.6，95%CI 0.50 - 0.64；45 - 54岁：AOR 0.4，95%CI 0.32 - 0.49；55 - 64岁：AOR 0.3，95%CI 0.21 - 0.43；64岁以上：AOR 0.3，95%CI 0.19 - 0.35）。接受抗逆转录病毒治疗（ART）的合并感染病例相对于ART状态未知的病例，结核病治疗中断的可能性低40%（AOR 0.6，95%CI 0.46 - 0.57）。
在自由邦省，显著因素影响结核病患者的治疗中断情况。因此，建议加强针对治疗中断高风险患者的临床和项目干预措施。特别是，为合并感染病例提供ART有助于提高结核病治疗的依从性和治疗效果。
