Htun Ye Minn, Khaing Tin Mi Mi, Yin Yin, Myint Zaw, Aung Si Thu, Hlaing Tin Maung, Soonthornworasiri Ngamphol, Silachamroon Udomsak, Kasetjaroen Yuthichai, Kaewkungwal Jaranit
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Regional Tuberculosis Center, Yangon, Myanmar.
BMC Health Serv Res. 2018 Nov 20;18(1):878. doi: 10.1186/s12913-018-3715-4.
Delays in diagnosis and treatment initiation may allow the emergence of new cases by transmission to the community, and is one of the challenges facing programme management of drug resistance in Myanmar. This study aimed to explore delays in diagnosis and treatment initiation, and associated factors among patients with multidrug-resistant tuberculosis.
A cross-sectional study was conducted at Yangon Regional Tuberculosis Centre, Myanmar. Data were collected by face-to-face interviews and treatment-card reviews of all adult patients who had registered and started treatment with the standard regimen from May to November, 2017. Delay time was categorized by using median cut-off and analyzed using SPSS version 23.0. Logistic regression analysis was performed to assess the relative impact of predictor variables on diagnosis and treatment delays.
A total of 210 patients participated in this study. The median diagnosis delay was 9 days, IQR 3 (8-11) and 58.6% of the patients experienced a long diagnosis delay. Below middle school education (adjusted odds ratio [AOR] = 2.75, 95% CI = 1.22-6.21), non-permanent salaried employment (AOR = 3.03, 95% CI = 1.32-6.95), co-existing diabetes mellitus (AOR = 5.06, 95% CI = 1.97-13.01) and poor awareness (AOR = 2.99, 95% CI = 1.29-6.92) were independent predictors of long diagnosis delay. The median treatment delay was 13 days, IQR 9 (8-17) and 51% of the patients experienced long treatment delay. Age 31-50 years (AOR = 4.50, 95% CI = 1.47-13.97) and age > 50 years (AOR = 9.40, 95% CI = 2.55-34.83), history with MDR-TB patient (AOR = 3.16, 95% CI = 1.29-7.69), > 20 km away from a Regional TB Centre (AOR = 14.33, 95% CI = 1.91-107.64) and poor awareness (AOR = 4.62, 95% CI = 1.56-13.67) were independent predictors of long treatment delay.
Strengthening comprehensive health education, enhancing treatment adherence counseling, providing more Xpert MTB/RIF machines, expanding decentralized MDR-TB treatment centers, ensuring timely sputum transportation, provision of a patient support package immediately after confirmation, and strengthening contact-tracing for all household contacts with MDR-TB patients and active tuberculosis screening were the most effective ways to shorten delays in MDR-TB diagnosis and treatment initiation.
诊断和开始治疗的延迟可能会因传播至社区而导致新病例出现，这是缅甸耐药结核病项目管理面临的挑战之一。本研究旨在探讨耐多药结核病患者的诊断和开始治疗的延迟情况及相关因素。
在缅甸仰光地区结核病中心进行了一项横断面研究。通过面对面访谈和对2017年5月至11月期间登记并开始采用标准方案治疗的所有成年患者的治疗卡审查来收集数据。使用中位数截断法对延迟时间进行分类，并使用SPSS 23.0版进行分析。进行逻辑回归分析以评估预测变量对诊断和治疗延迟的相对影响。
共有210名患者参与了本研究。诊断延迟的中位数为9天，四分位间距为3（8 - 11），58.6%的患者经历了较长的诊断延迟。初中以下文化程度（调整比值比[AOR]=2.75，95%置信区间[CI]=1.22 - 6.21）、非固定薪资就业（AOR = 3.03，95% CI = 1.32 - 6.95）、并存糖尿病（AOR = 5.06，95% CI = 1.97 - 13.01）和意识淡薄（AOR = 2.99，95% CI = 1.29 - 6.92）是较长诊断延迟的独立预测因素。治疗延迟的中位数为13天，四分位间距为9（8 - 17），51%的患者经历了较长的治疗延迟。31 - 50岁（AOR = 4.50，95% CI = 1.47 - 13.97）和年龄>50岁（AOR = 9.40，95% CI = 2.55 - 34.83）、有耐多药结核病患者接触史（AOR = 3.16，95% CI = 1.29 - 7.69）、距离地区结核病中心>20公里（AOR = 14.33，95% CI = 1.91 - 107.64）和意识淡薄（AOR = 4.62，95% CI = 1.56 - 13.67）是较长治疗延迟的独立预测因素。
加强全面健康教育、加强治疗依从性咨询、提供更多的Xpert MTB/RIF检测仪、扩大耐多药结核病分散治疗中心、确保痰液及时运送、确诊后立即提供患者支持包以及加强对所有耐多药结核病患者家庭接触者的接触者追踪和活动性结核病筛查是缩短耐多药结核病诊断和开始治疗延迟的最有效方法。
