Tafess Ketema, Beyen Teresa Kisi, Abera Adugna, Tasew Geremew, Mekit Shimelis, Sisay Solomon, Tadesse Legesse, Siu Gilman K H
Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
Department of Medical Laboratory, College of Health Sciences, Arsi University, Asella, Ethiopia.
Front Med (Lausanne). 2018 Feb 21;5:38. doi: 10.3389/fmed.2018.00038. eCollection 2018.
Directly Observed Treatment Short-course (DOTS) has been one of the major strategies to combat the epidemic of tuberculosis (TB) globally. This study aimed to evaluate TB treatment outcomes between September 2004 and July 2014 under the DOTS program at one of the largest public hospitals in Ethiopia.
A retrospective data of TB patients registered at Asella Teaching Hospital between September 2004 and July 2014 were obtained from hospital registry. Treatment outcomes and types of TB cases were categorized according to the national TB control program guideline. Binomial and multinomial logistic regression models were used to analyze the association between treatment outcomes and potential predictor variables.
A total of 1,755 TB patients' records were included in the study. Of these, 945 (53.8%) were male, 480 (27.4%) smear-positive TB, 287 (16.4%) HIV positive, and 1,549 (88.3%) new cases. Among 480 smear-positive pulmonary TB cases, 377 (78.5%) patients were cured, 21 (4.40) completed the treatment, 35 (7.3%) transferred out, 19 (4.0%) died, 24 (5.0%) defaulted, and 4 (0.8%) failure. Overall, 398 (82.9%) smear-positive pulmonary TB patients were successfully treated. For smear-negative TB ( = 641) and extrapulmonary TB cases ( = 634), 1,036 (81.3%) completed the treatment and demonstrated favorable response. Taking all TB types into account, 1,434 (81.7%) were considered as successfully treated. In the multivariate binary logistic model, patients in older age group (AOR = 0.386, 95% CI: 0.250-0.596) and retreatment cases (AOR = 0.422, 95% CI: 0.226-0.790) were less likely to be successfully treated compared to younger and new cases, respectively. In multinomial logistic regression, age increment by 1 year increased the risk of death and default of TB patients by 0.05 (adjusted β = 0.05; 95% CI: 0.03, 0.06) and 0.02 (adjusted β = 0.02; 95% CI: 0.01, 0.04). The odds of TB patients who died during treatment were higher among HIV-infected TB patients (adjusted β = 2.65; 95% CI: 1.28, 5.50).
The treatment success rate of TB patients was low as compared to the national target. TB control needs to be strengthened for the enhancement of treatment outcome.
直接面视下短程疗法（DOTS）一直是全球抗击结核病流行的主要策略之一。本研究旨在评估2004年9月至2014年7月期间，在埃塞俄比亚最大的公立医院之一实施的DOTS项目下的结核病治疗效果。
从医院登记处获取2004年9月至2014年7月在阿塞拉教学医院登记的结核病患者的回顾性数据。根据国家结核病控制项目指南对治疗效果和结核病病例类型进行分类。采用二项式和多项逻辑回归模型分析治疗效果与潜在预测变量之间的关联。
本研究共纳入1755例结核病患者的记录。其中，男性945例（53.8%），涂片阳性结核病患者480例（27.4%），HIV阳性患者287例（16.4%），新发病例1549例（88.3%）。在480例涂片阳性肺结核病例中，377例（78.5%）患者治愈，21例（4.4%）完成治疗，35例（7.3%）转出，19例（4.0%）死亡，24例（5.0%）中断治疗，4例（0.8%）治疗失败。总体而言，398例（82.9%）涂片阳性肺结核患者得到成功治疗。对于涂片阴性结核病患者（n = 641）和肺外结核病例（n = 634），1036例（81.3%）完成治疗并显示出良好反应。综合所有结核病类型，1434例（81.7%）被视为成功治疗。在多变量二元逻辑模型中，与年轻患者和新发病例相比，老年组患者（调整后比值比[AOR]=0.386，95%置信区间[CI]：0.250 - 0.596）和复治病例（AOR = 0.422，95% CI：0.226 - 0.790）成功治疗的可能性较小。在多项逻辑回归中，年龄每增加1岁，结核病患者死亡和中断治疗的风险分别增加0.05（调整后β=0.05；95% CI：0.03，0.06）和0.02（调整后β=0.02；95% CI：0.01，0.04）。在治疗期间死亡的结核病患者中，HIV感染的结核病患者的几率更高（调整后β=2.65；95% CI：1.28，5.50）。
与国家目标相比，结核病患者的治疗成功率较低。需要加强结核病控制以提高治疗效果。
