Lin Y, Enarson D A, Du J, Dlodlo R A, Chiang C-Y, Rusen I D
International Union Against Tuberculosis and Lung Disease (The Union), Beijing, China.
The Union, Paris, France.
Public Health Action. 2017 Dec 21;7(4):299-303. doi: 10.5588/pha.17.0056.
Three projects of the Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB. To assess unfavourable treatment outcomes (UTOs), including failure, died, loss to follow-up (LTFU), transferred out and unknown outcome, and to identify risk factors associated with UTOs. This was a cross-sectional study using routine programme data. Of 30 277 new smear-positive tuberculosis (TB) patients, 4261 (14.1%) had UTOs: 2048 (6.8%) LTFU, 1418 (4.7%) transferred out, 390 (1.3%) died, 340 (1.1%) failed and 65 (0.2%) had an unknown outcome. Risk factors for LTFU (including LTFU, transfer out and unknown outcome) were residing in Anhui, age > 55 years, service delay > 10 days, patient delay < 30 days, directly observed treatment (DOT) provided by a family member or others and unknown DOT provider. The outcome of 'died' was associated with residing in Shaanxi, age > 55 years, male sex, patient delay > 30 days and unknown DOT provider. 'Failed' was associated with having unlimited access to health services, patient delay of >30 days and unknown DOT provider. This study highlights the predominance of lost patients among UTOs. Patients with family members or other non-medical DOT providers or unknown DOT providers had a high risk of a UTO. There is an urgent need to address these service-related factors.
通过地方倡议扩大创新型直接观察治疗短程化疗以终止结核病基金的三个项目。评估不良治疗结果（UTO），包括治疗失败、死亡、失访（LTFU）、转出及结局不明，并确定与UTO相关的风险因素。这是一项利用常规项目数据的横断面研究。在30277例新的涂片阳性肺结核患者中，4261例（14.1%）出现UTO：2048例（6.8%）失访，1418例（4.7%）转出，390例（1.3%）死亡，340例（1.1%）治疗失败，65例（0.2%）结局不明。失访（包括失访、转出及结局不明）的风险因素包括居住在安徽、年龄>55岁、服务延迟>10天、患者延迟<30天、由家庭成员或其他人提供直接观察治疗（DOT）以及DOT提供者不明。“死亡”结局与居住在陕西、年龄>55岁、男性、患者延迟>30天以及DOT提供者不明有关。“治疗失败”与可无限制获得医疗服务、患者延迟>30天以及DOT提供者不明有关。本研究突出了失访患者在UTO中占主导地位。由家庭成员或其他非医疗人员提供DOT或DOT提供者不明的患者发生UTO的风险较高。迫切需要解决这些与服务相关的因素。
