Claassens M M, Dunbar R, Yang B, Lombard C J
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Biostatistics Unit, South African Medical Research Council, Parow, South Africa.
Int J Tuberc Lung Dis. 2017 Feb 1;21(2):196-201. doi: 10.5588/ijtld.16.0292.
Smear-positive patients should be started on anti-tuberculosis treatment promptly. However, studies show that up to 38% of diagnosed patients are initial loss to follow-up (LTFU), meaning they do not start treatment after diagnosis. We investigated determinants of initial LTFU at primary health care facilities.
In a facility-matched case-control study, health care facilities were visited from October 2010 to September 2012. After identification from registers, patients were traced and invited to complete a questionnaire.
Of 973 participants, 233 (24%) were cases and 740 (74%) controls. Initial LTFU was associated with smear grade (pooled adjusted odds ratio [aOR] 0.73, 95% confidence interval [CI] 0.64-0.90, scanty at baseline) for participants identified at facilities, but not with age (overall P = 0.80) or sex (aOR 0.83, 95%CI 0.58-1.20). Of the 233 cases, 197 (85%) were traced in the community, of whom 58 (29%) were found. Among the group found, initial LTFU was associated with age (aOR 3.38, 95%CI 1.15-9.95) and smear grade (aOR 0.08, 95%CI 0.02-0.34, scanty at baseline).
Scanty smear positivity was associated with initial LTFU. Tuberculosis programmes should start scanty smear-positive patients on treatment early and develop alternative community tracing strategies. Health care worker training could address the first aspect, and the use of technology to improve treatment initiation, such as mobile phone applications, the second.
涂片阳性患者应立即开始抗结核治疗。然而，研究表明，高达38%的确诊患者最初会失访，即他们在确诊后未开始治疗。我们调查了基层医疗保健机构中初始失访的决定因素。
在一项机构匹配的病例对照研究中，于2010年10月至2012年9月期间走访了医疗保健机构。从登记册中识别出患者后，对其进行追踪并邀请他们填写问卷。
在973名参与者中，233名（24%）为病例，740名（74%）为对照。对于在机构中识别出的参与者，初始失访与涂片分级相关（合并调整比值比[aOR]为0.73，95%置信区间[CI]为0.64 - 0.90，基线时涂片少量阳性），但与年龄（总体P = 0.80）或性别（aOR为0.83，95%CI为0.58 - 1.20）无关。在233例病例中，197例（85%）在社区中被追踪到，其中58例（29%）被找到。在被找到的这组人群中，初始失访与年龄（aOR为3.38，95%CI为1.15 - 9.95）和涂片分级（aOR为0.08，95%CI为0.02 - 0.34，基线时涂片少量阳性）相关。
涂片少量阳性与初始失访相关。结核病防治项目应尽早让涂片少量阳性患者开始治疗，并制定替代性的社区追踪策略。对医护人员的培训可以解决第一个方面的问题，而使用技术（如手机应用程序）来改善治疗启动则可以解决第二个方面的问题。
