Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti- tuberculosis Association (RIT/JATA), Tokyo, Japan.
the Research Institute of Tuberculosis, Japan Anti- tuberculosis Association (RIT/JATA), Tokyo, Japan.
PLoS One. 2018 Jun 15;13(6):e0198075. doi: 10.1371/journal.pone.0198075. eCollection 2018.
The treatment success rate of pulmonary tuberculosis (PTB) patients aged 64 years and below in Japan, a tuberculosis (TB) middle-burden country with a notification of 13.9 per 100,000 populations in 2016, has been fluctuating around 70% for some years. In order to improve treatment outcome, it is critical to address those lost to follow-up (LTFU). The objective of the study therefore was to describe the characteristics of, and analyze the risk factors for those LTFU among pulmonary TB patients aged between 15 and 64, and discuss policy implications.
The study used a mixed method of quantitative and qualitative approach, and was conducted in two phases. The first involved analysis of cohort data from the national TB surveillance of PTB patients newly notified between 1 January 2006 and 31 December 2015. The second phase involved focus group (FGD) discussions with public health nurses, who are responsible for supporting TB patients' adherence to medication, on the possible reasons why some patients become lost to follow-up.
Analysis of the surveillance data suggested that among all patients, positive sputum smear (adjusted odds ratio, [aOR] 0.52, 95% confidence interval [CI] 0.47-0.58) and cavitary lesion on chest x-ray (aOR 0.79, 95%CI 0.72-0.85) decreased the risk, while not requiring hospitalization increased the risk of LTFU (aOR 1.46, 95%CI 1.33-1.60). Among females, being a physician (aOR 2.07 95%CI 1.23-3.48) and nurse (aOR 1.18, 95%CI 1.91-1.37) were identified as additional risk factors for LTFU. The analysis of focus group discussions revealed three possible themes which may be useful in understanding why nurses and physicians were at a higher risk of becoming LTFU-firstly, the possibility that physicians and nurses were finding it difficult to make medication taking a routine, secondly, their low risk perception towards TB is affecting their adherence behavior, and thirdly, their unwillingness to accept DOTS was increasing their risk of becoming LTFU.
The analysis of surveillance data and FGD transcripts indicated that patient education for those starting their treatment as an outpatient, and establishing DOTS that is both acceptable and realistic to physicians and nurses, may be two issues which need to be addressed urgently.
在结核病（TB）中等负担国家日本，64 岁及以下的肺结核（PTB）患者的治疗成功率多年来一直在 70%左右波动，2016 年的通报率为每 10 万人中有 13.9 人。为了提高治疗效果，解决那些失访的患者至关重要。因此，本研究的目的是描述并分析 15 至 64 岁之间的肺结核患者中失访的特征和风险因素，并讨论政策意义。
本研究采用定量和定性相结合的混合方法，分两个阶段进行。第一阶段涉及对 2006 年 1 月 1 日至 2015 年 12 月 31 日期间新通报的肺结核患者的国家结核病监测队列数据进行分析。第二阶段是与负责支持结核病患者坚持药物治疗的公共卫生护士进行焦点小组（FGD）讨论，探讨为什么一些患者会失访的可能原因。
监测数据的分析表明，在所有患者中，痰涂片阳性（调整后的优势比[OR]0.52，95%置信区间[CI]0.47-0.58）和胸部 X 射线有空洞病变（OR 0.79，95%CI 0.72-0.85）降低了风险，而无需住院治疗则增加了失访的风险（OR 1.46，95%CI 1.33-1.60）。在女性中，医生（OR 2.07，95%CI 1.23-3.48）和护士（OR 1.18，95%CI 1.91-1.37）被确定为失访的额外风险因素。焦点小组讨论的分析揭示了三个可能的主题，这些主题可能有助于理解为什么医生和护士的失访风险更高：一是医生和护士可能发现难以将服药作为常规，二是他们对结核病的低风险认知影响了他们的遵医行为，三是他们不愿意接受直接督导下的短程化疗（DOTS）增加了他们的失访风险。
监测数据的分析和 FGD 记录表明，需要紧急解决开始门诊治疗的患者的教育问题，并建立医生和护士都可以接受和现实的 DOTS。
