Thu Myat K, Kumar Ajay M V, Soe Kyaw T, Saw Saw, Thein Saw, Mynit Zaw, Maung Htet M W, Aung Si T
National Tuberculosis Program, Disease Control Unit, Ministry of Health and Sports, Zabu Thiri Township, Nay Pyi Taw, Republic of the Union of Myanmar.
International Union Against Tuberculosis and Lung Disease, Paris, France.
Trans R Soc Trop Med Hyg. 2017 Sep 1;111(9):410-417. doi: 10.1093/trstmh/trx074.
Since 2011, Myanmar has adopted domiciliary care for multidrug-resistant tuberculosis (MDR-TB) patients and implemented several patient-support measures such as community-based directly observed treatment, nutritional support and financial incentives for patients and providers. We assessed treatment outcomes among MDR-TB patients registered for treatment in the Yangon and Mandalay Regions of Myanmar during 2012-2014 and factors associated with unfavourable treatment outcomes.
We performed a retrospective cohort study involving secondary analysis of routine programmatic data extracted from the electronic MDR-TB treatment registries. We calculated the adjusted risk ratio (aRR) and 95% confidence interval (CI).
Of 2185 MDR-TB patients (75% HIV tested, 14% HIV positive with 70% of them receiving antiretroviral therapy), 1746 (80%) were successfully treated (cured and treatment completed) and 20% had unfavourable outcomes (14% died, 3% lost to follow-up, 2% failure and 1% not evaluated). Compared with young patients (<25 y), patients 25-54 y of age (aRR 2.0 [95% CI 1.3 to 2.9]) and >55 y (aRR 3.2 [95% CI 2.1 to 4.8]) were more likely to have unfavourable outcomes. HIV-positive patients (especially not receiving ART; aRR 2.2 [95% CI 1.4 to 3.6]) and patients with 'unknown HIV status' (aRR 1.9 [95% CI 1.5-2.4]) had a higher risk of unfavourable outcomes compared with HIV-negative patients.
Treatment success was high and deaths accounted for three-fourths of unfavourable outcomes. Joint care and management of MDR-TB and HIV co-infected patients should be strengthened.
自2011年以来，缅甸对耐多药结核病（MDR-TB）患者采用居家护理，并实施了多项患者支持措施，如社区直接观察治疗、营养支持以及对患者和医护人员的经济激励。我们评估了2012年至2014年期间在缅甸仰光和曼德勒地区登记接受治疗的耐多药结核病患者的治疗结果以及与不良治疗结果相关的因素。
我们进行了一项回顾性队列研究，对从电子耐多药结核病治疗登记处提取的常规项目数据进行二次分析。我们计算了调整风险比（aRR）和95%置信区间（CI）。
在2185例耐多药结核病患者中（75%接受了HIV检测，14%为HIV阳性，其中70%接受了抗逆转录病毒治疗），1746例（80%）成功治愈（治愈且完成治疗），20%出现不良结果（14%死亡，3%失访，2%治疗失败，1%未评估）。与年轻患者（<25岁）相比，25至54岁的患者（aRR 2.0 [95% CI 1.3至2.9]）和>55岁的患者（aRR 3.2 [95% CI 2.1至4.8]）出现不良结果的可能性更高。与HIV阴性患者相比，HIV阳性患者（尤其是未接受抗逆转录病毒治疗的患者；aRR 2.2 [95% CI 1.4至3.6]）和“HIV状态不明”的患者（aRR 1.9 [95% CI 1.5 - 2.4]）出现不良结果的风险更高。
治疗成功率较高，死亡占不良结果的四分之三。应加强对耐多药结核病和HIV合并感染患者的联合护理和管理。
