Velavan A, Purty A J, Shringarpure K, Sagili K D, Mishra A K, Selvaraj K S, Manikandan M, Saravanan V
Department of Community Medicine, Pondicherry Institute of Medical Science (PIMS), Puducherry, India.
National Task Force, Revised National Tuberculosis Control Programme, New Delhi, India.
Public Health Action. 2018 Dec 21;8(4):187-193. doi: 10.5588/pha.18.0038.
Four Tuberculosis (TB) Units in the Union Territory of Puducherry in India. To identify factors associated with unfavourable outcomes among retreatment TB cases in Puducherry. The study had a mixed-methods design in which routinely reported TB data from retreatment TB cases registered during 2014 and 2015 were used for the quantitative part; the qualitative phase comprised interviews and focus group discussions with health care providers. Among the 392 retreatment cases, 297 (75.8%) had favourable outcomes. Outcome for previous treatment such as loss to follow-up (LTFU) (adjusted relative risk [aRR] 1.6, 95%CI 1.1-2.4, = 0.001), treatment failure (aRR 1.7, 95%CI 1.04-2.8, = 0.03) and pre-treatment weight <40 kg (aRR 1.8, 95%CI 1.3-2.5, = 0.001) had increased risk for unfavourable outcomes. Health care providers reported that alcoholism, lack of family support, job-related issues and lack of access to trained staff for injections were some of the reasons for unfavourable outcomes. Providing incentives, nutritional supplements and early retrieval of the LTFU cases were some of the suggestions to reduce unfavourable outcomes. Outcome of previous treatment and low pre-treatment weight of the patient affected retreatment outcomes. Health professionals and workers highlighted social and health system-related factors. Commitment at all levels on the part of health care providers and addressing their concerns can improve retreatment outcomes.
印度本地治里中央直辖区的四个结核病防治单位。旨在确定本地治里复治结核病病例中与不良结局相关的因素。该研究采用混合方法设计，其中2014年和2015年登记的复治结核病病例的常规报告结核病数据用于定量部分；定性阶段包括对医疗服务提供者的访谈和焦点小组讨论。在392例复治病例中，297例（75.8%）预后良好。既往治疗结局如失访（调整相对风险[aRR]1.6，95%可信区间1.1 - 2.4，P = 0.001）、治疗失败（aRR 1.7，95%可信区间1.04 - 2.8，P = 0.03）以及治疗前体重<40 kg（aRR 1.8，95%可信区间1.3 - 2.5，P = 0.001）的患者出现不良结局的风险增加。医疗服务提供者报告称，酗酒、缺乏家庭支持、工作相关问题以及缺乏接受过注射培训的工作人员是导致不良结局的部分原因。提供激励措施、营养补充剂以及早期找回失访病例是减少不良结局的一些建议。既往治疗结局和患者治疗前低体重影响复治结局。卫生专业人员和工作者强调了社会和卫生系统相关因素。医疗服务提供者在各级的承诺以及解决他们的担忧可以改善复治结局。
