Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Division of infectious diseases, University of North Carolina, Chapel Hill, United States of America.
PLoS One. 2018 Oct 9;13(10):e0205463. doi: 10.1371/journal.pone.0205463. eCollection 2018.
Treatment success rates of rifampicin resistant (RR)/multi-drug resistant (MDR) tuberculosis (TB) in South Africa range from 43-48%, falling short of the World Health Organization's target of ≥75%. We present rates and assess predictors of attrition by 12 months on treatment.
Prospective observational cohort analysis of adults (≥18 years) initiating RR/MDR-TB treatment from 01 March 2013 to 30 September 2016. Attrition was defined as a combination of death and loss to follow-up (LTFU; treatment interruption ≥2 months) by 12 months on treatment. Predictors of attrition were identified using Cox Proportional Hazards models to estimate crude (HR) and adjusted hazard ratios (aHR) with corresponding 95% confidence intervals.
By 12 months on treatment, 75/240 (31.3%) patients had either died (37/240; 15.4%) or been LTFU (38/240; 15.8%). Patients with moderate/severe anaemia (aHR: 2.10; 95% CI 1.00-4.39), and those who were smear positive at baseline (aHR: 2.04; 95% CI 1.01-4.12) were significantly more likely to die or be lost from care.
At this outpatient DR-TB treatment site, there was a high rate of attrition halfway through the standard treatment course at 12 months of 31%. High rates of attrition by 12 months on treatment may continue during the second-half of therapy.
南非利福平耐药（RR）/耐多药（MDR）结核病（TB）的治疗成功率为 43-48%，低于世界卫生组织 75%的目标。我们报告了治疗 12 个月时的失访率，并评估了其预测因素。
对 2013 年 3 月 1 日至 2016 年 9 月 30 日期间开始 RR/MDR-TB 治疗的成年人（≥18 岁）进行前瞻性观察队列分析。失访定义为治疗 12 个月时死亡和失访（治疗中断≥2 个月）的组合。使用 Cox 比例风险模型识别失访的预测因素，以估计粗（HR）和调整后的危险比（aHR）及其相应的 95%置信区间。
治疗 12 个月时，75/240（31.3%）患者死亡（37/240；15.4%）或失访（38/240；15.8%）。中重度贫血患者（aHR：2.10；95%CI 1.00-4.39）和基线时痰涂片阳性的患者（aHR：2.04；95%CI 1.01-4.12）更有可能死亡或失去治疗。
在这个门诊 DR-TB 治疗点，在标准治疗疗程的 12 个月时，失访率高达 31%，中途失访率很高。治疗 12 个月时的高失访率可能会在治疗的后半程继续。
