Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Road, Glebe, New South Wales 2037, Australia.
Global TB Programme, World Health Organization, Geneva, Switzerland.
Bull World Health Organ. 2017 Aug 1;95(8):584-593. doi: 10.2471/BLT.17.193375.
To assess the effectiveness of decentralized treatment and care for patients with multidrug-resistant (MDR) tuberculosis, in comparison with centralized approaches.
We searched ClinicalTrials.gov, the Cochrane library, Embase®, Google Scholar, LILACS, PubMed®, Web of Science and the World Health Organization's portal of clinical trials for studies reporting treatment outcomes for decentralized and centralized care of MDR tuberculosis. The primary outcome was treatment success. When possible, we also evaluated, death, loss to follow-up, treatment adherence and health-system costs. To obtain pooled relative risk (RR) estimates, we performed random-effects meta-analyses.
Eight studies met the eligibility criteria for review inclusion. Six cohort studies, with 4026 participants in total, reported on treatment outcomes. The pooled RR estimate for decentralized versus centralized care for treatment success was 1.13 (95% CI: 1.01-1.27). The corresponding estimate for loss to follow-up was RR: 0.66 (95% CI: 0.38-1.13), for death RR: 1.01 (95% CI: 0.67-1.52) and for treatment failure was RR: 1.07 (95% CI: 0.48-2.40). Two of three studies evaluating health-care costs reported lower costs for the decentralized models of care than for the centralized models.
Treatment success was more likely among patients with MDR tuberculosis treated using a decentralized approach. Further studies are required to explore the effectiveness of decentralized MDR tuberculosis care in a range of different settings.
评估与集中式方法相比，为耐多药（MDR）肺结核患者提供分散式治疗和护理的效果。
我们在 ClinicalTrials.gov、Cochrane 图书馆、Embase®、Google Scholar、LILACS、PubMed®、Web of Science 和世界卫生组织临床试验门户中检索了报告 MDR 肺结核分散式和集中式护理治疗结果的研究。主要结局是治疗成功。在可能的情况下，我们还评估了死亡、失访、治疗依从性和卫生系统成本。为了获得汇总相对风险（RR）估计值，我们进行了随机效应荟萃分析。
有 8 项研究符合综述纳入标准。6 项队列研究共纳入 4026 名参与者，报告了治疗结果。与集中式护理相比，分散式护理的治疗成功率的汇总 RR 估计值为 1.13（95%CI：1.01-1.27）。失访的相应 RR 估计值为 0.66（95%CI：0.38-1.13），死亡的 RR 估计值为 1.01（95%CI：0.67-1.52），治疗失败的 RR 估计值为 1.07（95%CI：0.48-2.40）。评估卫生保健成本的三项研究中有两项报告，分散式护理模式的成本低于集中式护理模式。
采用分散式方法治疗的 MDR 肺结核患者更有可能治疗成功。需要进一步研究以探索在各种不同环境下分散式 MDR 肺结核护理的效果。
