津巴布韦南部省份引入 Hain 线探针检测后，耐利福平结核病患者二线药物药敏检测结果的可及性。

Access to second-line drug susceptibility testing results among patients with Rifampicin resistant tuberculosis after introduction of the Hain Line Probe Assay in Southern provinces, Zimbabwe.

机构信息

Ministry of Health and Child Care, National AIDS & TB Control Program, Harare, Zimbabwe; International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union, Harare, Zimbabwe.

Ministry of Health and Child Care, National AIDS & TB Control Program, Harare, Zimbabwe.

出版信息

Int J Infect Dis. 2019 Apr;81:236-243. doi: 10.1016/j.ijid.2019.02.007. Epub 2019 Feb 15.

DOI:10.1016/j.ijid.2019.02.007

PMID:30776546

Abstract

OBJECTIVES

To determine the proportion of rifampicin-resistant tuberculosis (RR-TB) patients who accessed second-line drug susceptibility testing (SL-DST) results following introduction of the Hain technology in southern provinces, Zimbabwe.

DESIGN

Cohort study using secondary data.

RESULTS

Xpert MTB/RIF results were used to identify 133 RR-TB patients for this study. Their mean age (SD) was 37.9 (11.1) years, 83 (62%) were males and 106 (80%) were HIV-infected. There were 6 (5%) participants who had pre-treatment attrition. Of the 133 pulmonary TB (PTB) patients, 117 (80%) had additional sputum specimens collected; 96 (72%) specimens reached the National TB Reference Laboratory (NTBRL); 95 (71%) were processed; 68 (51%) had SL-DST results. Only 53 (40%) SL-DST results reached the peripheral facilities. Median time from specimen reception at the NTBRL to SL-DSTs was 40 days, interquartile range (IQR: 28-67). Median time from presumptive diagnosis of RR-TB by health care worker to SL-DST results was 50days (IQR: 39-80), and increased to 79days (IQR: 39-101) in facilities >250km from the NTBRL. The proportion with any fluoroquinolone resistance was 9 (13.2%).

CONCLUSION

Although RR-TB patients with PTB were initiated timely on treatment, access to SL-DSTs by facilities needs improvement. Health inequities exist as remote areas are less likely to get SL-DST results in time.

摘要

目的

在津巴布韦南部省份引入海因技术后，确定接受二线药物敏感性测试（SL-DST）结果的利福平耐药结核病（RR-TB）患者比例。

设计

使用二级数据的队列研究。

结果

使用 Xpert MTB/RIF 结果鉴定了 133 例 RR-TB 患者进行本研究。他们的平均年龄（SD）为 37.9（11.1）岁，83 名（62%）为男性，106 名（80%）为 HIV 感染者。有 6 名（5%）参与者存在治疗前流失。在 133 例肺结核（PTB）患者中，有 117 例（80%）采集了额外的痰液标本；96 例（72%）标本到达国家结核病参考实验室（NTBRL）；95 例（71%）进行了处理；68 例（51%）有 SL-DST 结果。只有 53 例（40%）SL-DST 结果到达了周边设施。从 NTBRL 接收标本到 SL-DST 的中位数时间为 40 天，四分位距（IQR：28-67）。从保健工作者初步诊断 RR-TB 到 SL-DST 结果的中位数时间为 50 天（IQR：39-80），在距离 NTBRL 超过 250 公里的设施中，这一时间增加到 79 天（IQR：39-101）。有氟喹诺酮耐药性的比例为 9 例（13.2%）。