University Research Co., LLC, Dhaka, Bangladesh.
University Research Co., LLC, Chevy Chase, MD, USA.
Glob Health Sci Pract. 2018 Oct 4;6(3):594-602. doi: 10.9745/GHSP-D-17-00345. Print 2018 Oct 3.
Bangladesh is a highly populous country where the prevalence of drug-resistant tuberculosis (DR-TB) is growing. With the rapid increase in DR-TB notifications through GeneXpert technology, it was imperative to come up with a new treatment strategy that could keep up with the increase of patients diagnosed.
Intervention was designed to support national transition of DR-TB management of World Health Organization-approved long course (20-to-24-month regimen) treatment from a hospital-based approach to the decentralized model of community-based programmatic management of DR-TB (cPMDT). In close coordination with the Ministry of Health and Family Welfare and National TB Program, patients were initiated into treatment at hospitals and then transferred to community-based care. A cadre of directly observed therapy providers supported treatment at the household level, supervised by the outpatient DR-TB teams.
We conducted a descriptive pre- and post-intervention study of all 1,946 DR-TB patients enrolled in treatment nationwide between May 2012 and June 2015. Data were collected from hospitals, patient cards, district records, and diagnostic laboratories through the National TB Program. Intervention results were assessed in comparison with the baseline (2011) indicators.
During the intervention period, treatment enrollment of 1,946 diagnosed DR-TB patients through the national program increased from 50% in 2011 to 100% in 2015. The delay between diagnosis and treatment initiation decreased from 69 days in 2011 to 6 days in 2014. Most (95%) of the patients completed all scheduled follow-up smear and culture tests. By the sixth month of treatment, 99% of patients had negative smear conversion and 98% had negative culture conversion. The treatment success rate increased from 70% in 2011 to 76% in 2015 at the end of the intervention period. The results also indicate a decline between baseline and end line from 14% to 9% for patients died, 14% to 10% for loss to follow-up, and 1.7% to 0% for treatment failure.
Community-based management is an effective approach for increasing access to quality-assured DR-TB treatment. Using existing structures and resources, the intervention demonstrated that favorable treatment outcomes can be achieved and sustained by treating patients with DR-TB at their homes.
孟加拉国是一个人口众多的国家，其耐多药结核病（DR-TB）的患病率不断上升。随着 GeneXpert 技术检测出的耐多药结核病病例的迅速增加，有必要制定新的治疗策略，以应对不断增加的患者数量。
该干预措施旨在支持孟加拉国将世界卫生组织批准的长程（20-24 个月疗程）治疗方案从以医院为基础的方法转变为社区为基础的有规划的耐多药结核病管理（cPMDT）的分散模式。在与卫生和家庭福利部以及国家结核病规划密切协调的情况下，患者在医院开始接受治疗，然后转至社区护理。一批直接观察治疗提供者在门诊耐多药结核病小组的监督下，在家庭层面支持治疗。
我们对 2012 年 5 月至 2015 年 6 月期间全国范围内接受治疗的 1946 名耐多药结核病患者进行了描述性的干预前后研究。数据通过国家结核病规划从医院、患者卡片、地区记录和诊断实验室收集。通过与基线（2011 年）指标进行比较，评估干预结果。
在干预期间，通过国家规划诊断为耐多药结核病的 1946 名患者的治疗登记人数从 2011 年的 50%增加到 2015 年的 100%。从诊断到开始治疗的延迟从 2011 年的 69 天减少到 2014 年的 6 天。大多数（95%）患者完成了所有计划的随访涂片和培养检查。治疗的第六个月时，99%的患者痰涂片转阴，98%的患者培养转阴。治疗成功率从 2011 年的 70%增加到 2015 年干预结束时的 76%。结果还表明，从基线到终点，死亡患者从 14%下降到 9%，失访患者从 14%下降到 10%，治疗失败患者从 1.7%下降到 0%。
基于社区的管理是增加获得高质量耐多药结核病治疗机会的有效方法。该干预措施利用现有的结构和资源，证明通过在家中治疗耐多药结核病患者，可以实现并维持有利的治疗结果。
