Directorate-General of Health, Lisbon, Portugal.
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.
Eur J Clin Microbiol Infect Dis. 2020 Apr;39(4):647-656. doi: 10.1007/s10096-019-03765-y. Epub 2019 Dec 3.
There is conflicting evidence about factors associated with failure to complete treatment (FCT) for latent tuberculosis infection (LTBI). We aim to identify the geographic, sociodemographic, and medical factors associated with FCT in Portugal, highlighting the two main metropolitan areas of Porto and Lisbon. We performed a retrospective cohort study including LTBI patients that started treatment in Portugal between 2013 and 2017. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using multivariable logistic regression to identify geographic, sociodemographic, and medical factors associated with FCT. Data on completion of treatment were available for 15,478 of 17,144 patients (90.3%). Of those, 2132 (13.8%) failed to complete treatment. Factors associated with FCT were being older than 15 years (aOR, 1.65 (95% CI = 1.34-2.05) for those aged 16 to 29), being born abroad (aOR, 2.04 (95% CI = 1.19-3.50) for Asia; aOR, 1.57 (95% CI = 1.24-1.98) for Africa), having a chronic disease (aOR, 1.29 (95% CI = 1.04-1.60)), alcohol abuse (aOR, 2.24 (95% CI = 1.73-2.90)), and being intravenous drug user (aOR, 1.68 (95% CI = 1.05-2.68)). Three-month course treatment with isoniazid plus rifampicin was associated with decreased FCT when compared with 6- or 9-month courses of isoniazid-only (aOR, 0.59 (95% CI = 0.45-0.77)). In Lisbon metropolitan area, being born in Africa, and in Porto metropolitan area, alcohol abusing and being intravenous drug user were distinctive factors associated with FCT. Sociodemographic and medical factors associated with FCT may vary by geographical area and should be taken into account when planning interventions to improve LTBI treatment outcomes. This study reinforces that shorter course treatment for LTBI might reduce FCT.
关于潜伏性结核感染 (LTBI) 治疗失败 (FCT) 相关因素的证据相互矛盾。我们的目的是确定与葡萄牙 FCT 相关的地理、社会人口学和医学因素，重点关注波尔图和里斯本这两个主要的大都市区。我们进行了一项回顾性队列研究，纳入了 2013 年至 2017 年间在葡萄牙开始治疗的 LTBI 患者。我们使用多变量逻辑回归计算了调整后的优势比 (aOR) 和 95%置信区间 (95%CI)，以确定与 FCT 相关的地理、社会人口学和医学因素。在 17144 名患者中，有 15478 名(90.3%)完成了治疗。其中，2132 名(13.8%)未完成治疗。与 FCT 相关的因素包括年龄超过 15 岁(aOR，16-29 岁者为 1.65 (95%CI = 1.34-2.05))、出生在国外(aOR，亚洲人为 2.04 (95%CI = 1.19-3.50)；非洲人为 1.57 (95%CI = 1.24-1.98))、患有慢性病(aOR，1.29 (95%CI = 1.04-1.60))、酗酒(aOR，2.24 (95%CI = 1.73-2.90))和静脉吸毒者(aOR，1.68 (95%CI = 1.05-2.68))。与 6 个月或 9 个月异烟肼单药疗程相比，3 个月异烟肼加利福平疗程与 FCT 降低相关(aOR，0.59 (95%CI = 0.45-0.77))。在里斯本大都市区，出生在非洲，在波尔图大都市区，酗酒和静脉吸毒是与 FCT 相关的独特因素。与 FCT 相关的社会人口学和医学因素可能因地理区域而异，在规划改善 LTBI 治疗结果的干预措施时应予以考虑。本研究进一步证实，较短疗程治疗 LTBI 可能会降低 FCT。
