博茨瓦纳人类免疫缺陷病毒相关结核病护理：来自真实环境的证据。

Human immunodeficiency virus-associated tuberculosis care in Botswana: evidence from a real-world setting.

机构信息

Palapye District Health Management Team, Department of Clinical services, Ministry of Health and wellness, PO Box 31, Palapye, 267, Botswana.

Department of Clinical services, Princess Marina Hospital, Ministry of Health and wellness, PO Box 258, Gaborone, 267, Botswana.

出版信息

BMC Infect Dis. 2019 Sep 2;19(1):767. doi: 10.1186/s12879-019-4401-9.

DOI:10.1186/s12879-019-4401-9

PMID:31477055

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6720078/

Abstract

BACKGROUND

Tuberculosis (TB) is among the world's top public health challenges and the leading killer of people with HIV, yet is a treatable disease. This study aimed to assess, in a real-world setting, the implementation of antiretroviral therapy (ART) and Cotrimoxazole preventive therapy (CPT) policy, specific interventions proven to benefit patients in HIV-associated TB care.

METHODS

This retrospective cohort study was conducted in Botswana in the Serowe/Palapye district, a largely urban district with a high burden of HIV-associated TB with a high case fatality, at Segkoma and Palapye hospitals and their feeder clinics. Between 1 January 2013 and 31 December 2013, confirmed HIV-positive patients aged ≥15 years with a confirmed TB diagnosis and medical record available were included in the analysis. The Kaplan-Meier method was used to compare time to death for the group of patients on ART and the group of patients not on ART during TB treatment. Cox proportional hazard regression was undertaken to identify predictors of mortality.

RESULTS

Of the 300 patients included in the study, 217 (72%) were ART experienced at TB diagnosis. Of these, 86 (40%) had TB within 3 months following ART initiation. Of the 83 (28%) patients who were ART-naïve at TB diagnosis, 40 (48%) were commenced on ART during TB treatment, with 24 (60%) patients commencing within 4 weeks following TB treatment initiation. The overall ART uptake was 84%, while cotrimoxazole preventive therapy uptake was 100%. There were 45 deaths (15%), ART-experienced patients during TB treatment accounted for 30 deaths (30/257; 14%), while those who were not ART-experienced during TB treatment accounted for 15 deaths (15/43; 35%). There was a significant difference in survival time between patients with no ART use during TB treatment and those with ART use during TB treatment (log rank p < 0.001). Patients with no ART use during TB treatment were more likely to die within the first 2 months.

CONCLUSION

The implementation of CPT policy is a substantial success. Strengthening the implementation of ART policy could improve survival among HIV-associated TB patients.

摘要

背景

结核病（TB）是全球面临的重大公共卫生挑战之一，也是导致艾滋病毒感染者死亡的首要原因，但这种疾病是可以治疗的。本研究旨在评估在实际环境中，抗逆转录病毒疗法（ART）和复方磺胺甲噁唑预防治疗（CPT）政策的实施情况，这些政策都针对艾滋病毒相关结核病护理中可使患者受益的具体干预措施。

方法

本回顾性队列研究在博茨瓦纳塞罗韦/帕拉佩地区进行，该地区主要为城市地区，艾滋病毒相关结核病负担沉重，病死率高，在塞戈科马和帕拉佩耶医院及其附属诊所进行。纳入标准为：2013 年 1 月 1 日至 12 月 31 日期间，年龄≥15 岁且 HIV 检测阳性、确诊为结核病且病历记录完整的患者。采用 Kaplan-Meier 方法比较接受 ART 治疗组和未接受 ART 治疗组患者在结核病治疗期间的死亡时间。采用 Cox 比例风险回归确定死亡的预测因素。

结果

在纳入研究的 300 例患者中，217 例（72%）在诊断为结核病时已接受 ART 治疗。其中，86 例（40%）在开始 ART 后 3 个月内出现结核病。在诊断为结核病时未接受 ART 治疗的 83 例患者中，40 例（48%）在结核病治疗期间开始接受 ART 治疗，其中 24 例（60%）在结核病治疗开始后 4 周内开始接受 ART 治疗。总的 ART 使用率为 84%，而复方磺胺甲噁唑预防治疗的使用率为 100%。共发生 45 例死亡（15%），接受 ART 治疗的结核病患者中有 30 例死亡（30/257；14%），而未接受 ART 治疗的结核病患者中有 15 例死亡（15/43；35%）。在未接受 ART 治疗的结核病患者与接受 ART 治疗的结核病患者之间，生存时间有显著差异（log rank p<0.001）。未接受 ART 治疗的结核病患者更有可能在头 2 个月内死亡。