Htwe Ko Ko, Kyaw Nang Thu Thu, Kumar Ajay M V, Kyaw Khine Wut Yee, Oo Myo Minn, Thwin Thandar, Saw Saw, Aung Si Thu
1National TB Programme, Central-Mandalay Branch, Department of Public Health, Ministry of Health and Sports, Patheingyi Township, Mandalay Region Myanmar.
International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
Trop Med Health. 2019 May 2;47:30. doi: 10.1186/s41182-019-0154-9. eCollection 2019.
Pre-treatment loss to follow-up (PTLFU) among tuberculosis (TB) patients is a global public health problem, because such patients are highly infectious and experience high mortality. There is no published evidence on this issue from Myanmar.
To determine PTLFU and treatment delays (> 7 days duration between the date of diagnosis and starting anti-TB treatment) and their associated demographic, clinical, and health system-related factors among bacteriologically confirmed (sputum smear-positive and/or Xpert-positive) TB patients diagnosed in public health facilities of the Mandalay Region between January and June 2017.
This was a cohort study involving secondary analysis of routine programme data. Every bacteriologically confirmed TB patient in the laboratory register was tracked for at least 3 months in the treatment register. Patients neither found in the treatment register nor referred out for treatment were considered PTLFU.
Of the 1365 bacteriologically confirmed patients diagnosed, 1051 (77%) started on anti-TB treatment, 200 (15.6%) were referred for treatment to health facilities outside the study area, and 114 (8.4%, 95% CI 7.0%-9.9%) did not initiate anti-TB treatment (PTLFU). PTLFU was significantly higher in those with TB/HIV co-infected (18%), sputum smear-negative but Xpert MTB-positive patients (31%), and patients diagnosed at a moderate- or high-volume facility (> 50 patients tested form TB during the study period) (~ 10%). Of the 940 patients with dates recorded, 46 (5%) had a treatment delay of more than 7 days. Patients aged 45-64 years had higher risk of treatment delay compared to those aged 15-44 years. About 97% of records did not have a phone number recorded.
PTLFU and treatment delay were relatively low in the Mandalay Region. While this is reassuring, urgent steps must be taken to address those that are lost, which includes improving documentation of phone numbers to improve 'trackability', instituting proactive measures to trace patients lost in the care pathway, and introducing an indicator in the national tuberculosis programme (NTP) monthly report to monitor and review PTLFU. Patient subgroups with higher PTLFU should receive priority attention.
结核病患者治疗前失访是一个全球性的公共卫生问题，因为这类患者具有高度传染性且死亡率高。缅甸尚未有关于此问题的公开证据。
确定2017年1月至6月在曼德勒地区公共卫生机构确诊的细菌学确诊（痰涂片阳性和/或Xpert阳性）结核病患者的治疗前失访情况和治疗延迟（诊断日期与开始抗结核治疗之间的间隔超过7天）及其相关的人口统计学、临床和卫生系统相关因素。
这是一项队列研究，涉及对常规项目数据的二次分析。实验室登记册中每例细菌学确诊的结核病患者在治疗登记册中至少跟踪3个月。在治疗登记册中未找到且未转诊接受治疗的患者被视为治疗前失访。
在1365例细菌学确诊患者中，1051例（77%）开始接受抗结核治疗，200例（15.6%）被转诊至研究区域外的卫生机构接受治疗，114例（8.4%，95%可信区间7.0%-9.9%）未开始抗结核治疗（治疗前失访）。结核病/艾滋病病毒合并感染患者（18%）、痰涂片阴性但Xpert MTB阳性患者（31%）以及在中型或大型机构确诊的患者（研究期间检测结核病患者超过50例）（约10%）的治疗前失访率显著更高。在记录了日期的940例患者中，46例（5%）治疗延迟超过7天。45-64岁的患者与15-44岁的患者相比，治疗延迟风险更高。约97%的记录未记录电话号码。
曼德勒地区的治疗前失访率和治疗延迟率相对较低。虽然这令人放心，但必须立即采取措施解决失访问题，包括改善电话号码记录以提高“可追踪性”，采取积极措施追踪在治疗过程中失访的患者，并在国家结核病项目（NTP）月度报告中引入一个指标以监测和审查治疗前失访情况。治疗前失访率较高的患者亚组应优先得到关注。
