乌干达的结核-艾滋病毒综合护理对结核病治疗结果产生持续积极影响。

Sustained positive impact on tuberculosis treatment outcomes of TB-HIV integrated care in Uganda.

机构信息

Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.

Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, Division of Intramural Research National Institute of Allergy and Infectious Diseases, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.

出版信息

Int J Tuberc Lung Dis. 2019 Apr 1;23(4):514-521. doi: 10.5588/ijtld.18.0306.

DOI:10.5588/ijtld.18.0306

PMID:31064632

Abstract

OBJECTIVE To examine tuberculosis (TB) treatment outcomes from a long-term TB-HIV (human immunodeficiency virus) integrated model of care at the Infectious Diseases Institute Clinic, Kampala, Uganda. METHODS We included HIV-positive adults who were new TB cases initiated on anti-tuberculosis treatment between 2009 and 2015 during TB-HIV integration. Trends in TB treatment outcomes and TB-associated deaths were analyzed using respectively the χ² trend test and Kaplan-Meier methods. RESULTS The analysis involved 1318 cases: most patients were female (>50%); the median age ranged from 34 to 36 years, and >60% were late presenters (CD4 count <200 cells/μl), with a median CD4 cell count of 100-146 cells/μl at TB diagnosis. TB treatment success (cured or treatment completed) was 67-76%. Loss to follow-up (LTFU) declined systematically from 7% in 2010 to 3.4% in 2015 ( < 0.01). Antiretroviral therapy (ART) initiation during the intensive phase improved from 47% in 2009 to 97% in 2015 ( < 0.01). The mortality rate was >15% over time, and the probability of death at month 2 of anti-tuberculosis treatment was 52% higher among late presenters than in early presenters (13% vs. 6%, < 0.01). CONCLUSION Significant LTFU improvement and prompt ART initiation could be due to well-implemented TB-HIV integration care; however, static TB-associated deaths may be due to late presentation. .

摘要

目的探讨乌干达坎帕拉传染病研究所临床部长期结核-艾滋病毒（human immunodeficiency virus）综合护理模式下的结核病（TB）治疗结局。方法我们纳入了 2009 年至 2015 年期间，在结核-艾滋病毒整合期间，开始接受抗结核治疗的新结核病例的艾滋病毒阳性成年人。分别采用 χ²趋势检验和 Kaplan-Meier 方法分析结核治疗结局和与结核相关的死亡趋势。结果分析共涉及 1318 例病例：大多数患者为女性（>50%）；中位年龄在 34 至 36 岁之间，超过 60%为晚期就诊者（CD4 计数<200 个/μl），TB 诊断时的中位 CD4 细胞计数为 100-146 个/μl。结核治疗成功率（治愈或治疗完成）为 67-76%。失访率（LTFU）从 2010 年的 7%系统地下降到 2015 年的 3.4%（<0.01）。强化期开始抗逆转录病毒治疗（ART）的比例从 2009 年的 47%提高到 2015 年的 97%（<0.01）。死亡率随时间推移超过 15%，晚期就诊者在抗结核治疗第 2 个月的死亡概率比早期就诊者高 52%（13%比 6%，<0.01）。结论 LTFU 显著改善和及时开始 ART 可能是由于实施了良好的结核-艾滋病毒综合护理；然而，静态的与结核相关的死亡可能是由于晚期就诊。 .