Aibana Omowunmi, Slavuckij Andrej, Bachmaha Mariya, Krasiuk Viatcheslav, Rybak Natasha, Flanigan Timothy P, Petrenko Vasyl, Murray Megan B
Division of General Internal Medicine, The University of Texas Health Science Center at Houston - McGovern Medical School, Houston, TX, USA.
World Health Organization, Illiyinskaya Street, Kyiv, Ukraine.
F1000Res. 2017 Oct 23;6:1873. doi: 10.12688/f1000research.12687.3. eCollection 2017.
: Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high. We evaluated baseline patient factors as predictors of poor DSTB treatment outcomes. : We conducted a retrospective analysis of new drug sensitive pulmonary TB patients treated in Kyiv Oblast, Ukraine between November 2012 and October 2014. We defined good treatment outcomes as cure or completion and poor outcomes as death, default or treatment failure. We performed logistic regression analyses, using routine program data, to identify baseline patient factors associated with poor outcomes. : Among 302 patients, 193 (63.9%) experienced good treatment outcomes while 39 (12.9%) failed treatment, 34 (11.3%) died, and 30 (9.9%) defaulted. In the multivariate analysis, HIV positive patients on anti-retroviral therapy (ART) [OR 3.50; 95% CI 1.46 - 8.42; p 0.005] or without ART (OR 4.12; 95% CI 1.36 - 12.43; p 0.01) were at increased risk of poor outcomes. Alcohol abuse (OR 1.81; 95% CI 0.93 - 3.55; p 0.08) and smear positivity (OR 1.75; 95% CI 1.03 - 2.97; p 0.04) were also associated with poor treatment outcomes. : High rates of poor outcomes among patients with newly diagnosed drug sensitive TB in Kyiv Oblast, Ukraine highlight the urgent need for programmatic interventions, especially aimed at patients with the highest risk of poor outcomes.
乌克兰药物敏感型肺结核（DSTB）患者的治疗效果不佳率较高，而全球DSTB的治疗成功率仍然很高。我们评估了基线患者因素，将其作为DSTB治疗效果不佳的预测指标。我们对2012年11月至2014年10月期间在乌克兰基辅州接受治疗的新诊断药物敏感型肺结核患者进行了回顾性分析。我们将良好的治疗效果定义为治愈或完成治疗，将不佳的治疗效果定义为死亡、失访或治疗失败。我们使用常规项目数据进行逻辑回归分析，以确定与不佳治疗效果相关的基线患者因素。在302名患者中，193名（63.9%）获得了良好的治疗效果，而39名（12.9%）治疗失败，34名（11.3%）死亡，30名（9.9%）失访。在多变量分析中，接受抗逆转录病毒治疗（ART）的HIV阳性患者[比值比（OR）3.50；95%置信区间（CI）1.46 - 8.42；p = 0.005]或未接受ART的患者（OR 4.12；95% CI 1.36 - 12.43；p = 0.01）出现不佳治疗效果的风险增加。酗酒（OR 1.81；95% CI 0.93 - 3.55；p = 0.08）和涂片阳性（OR 1.75；95% CI 1.03 - 2.97；p = 0.04）也与不佳的治疗效果相关。乌克兰基辅州新诊断的药物敏感型肺结核患者中不佳治疗效果的高发生率凸显了进行项目干预的迫切需求，尤其是针对治疗效果不佳风险最高的患者。
