Chókwè Carmelo Hospital-Daughters of Charity, Saint Vincent of Paul, Chókwè, Gaza Province, Mozambique.
Tinpswalo Association, Research Unit, Vincentian Association to Fight AIDS and TB, Chókwè, Gaza Province, Mozambique.
PLoS One. 2020 Mar 9;15(3):e0229995. doi: 10.1371/journal.pone.0229995. eCollection 2020.
Global roll out of Xpert MTB/RIF technology has resulted in dramatic changes in TB diagnosis. However, benefits in resource-limited, high-burden TB/HIV settings, remain to be verified. In this paper we describe the characteristics of a large cohort of TB patients in a rural hospital in Southern Mozambique before and after Xpert MTB/RIF introduction, together with some determinants of favorable treatment outcome.
We conducted a retrospective cohort study of TB infected patients ≥15 years of age, diagnosed and treated at Carmelo Hospital of Chókwè between January 1, 2006 and December 31, 2017. Patient demographic and clinical characteristics, and treatment outcomes were recorded and compared before and after Xpert MTB/RIF, which was introduced in the second semester of 2012.
9,655 patients were analyzed, with 44.1% females. HIV testing was conducted in 99.9% of patients, with 82.8% having TB/HIV co-infection. 73.2% of patients had a favorable treatment outcome. No increase was observed in the number of TB patients identified after introduction of Xpert MTB/RIF testing.
Upon introduction, Xpert testing seemed to have a punctual beneficial effect on TB treatment outcomes, however this effect apparently disappeared shortly afterwards. Challenges remain for integration of TB and HIV care, as worse outcomes are reported for those patients diagnosed with TB shortly after starting ART, and also for those never starting ART. The need of reasonably excluding TB disease before ART start should be highlighted to every health care provider engaged in HIV care.
全球推出 Xpert MTB/RIF 技术后，结核病诊断发生了巨大变化。然而，在资源有限、结核病/艾滋病负担沉重的环境中，其益处仍有待验证。本文描述了莫桑比克南部一所农村医院引入 Xpert MTB/RIF 前后大量结核病患者的特征，以及一些治疗结果良好的决定因素。
我们对 2006 年 1 月 1 日至 2017 年 12 月 31 日在 Chókwè 的 Carmelo 医院诊断和治疗的年龄≥15 岁的结核感染患者进行了回顾性队列研究。记录并比较了 Xpert MTB/RIF 引入（2012 年第二学期）前后患者的人口统计学和临床特征以及治疗结果。
共分析了 9655 例患者，其中 44.1%为女性。对 99.9%的患者进行了 HIV 检测，其中 82.8%为结核病/艾滋病合并感染。73.2%的患者治疗结果良好。引入 Xpert MTB/RIF 检测后，发现的结核病患者数量没有增加。
Xpert 检测引入后，似乎对结核病治疗结果产生了及时的有益影响，但此后这种影响显然消失了。结核病和艾滋病护理整合仍然存在挑战，因为那些在开始接受抗逆转录病毒治疗后不久被诊断出结核病的患者以及那些从未开始接受抗逆转录病毒治疗的患者的预后较差。应向参与艾滋病护理的每位医疗保健提供者强调，在开始抗逆转录病毒治疗前合理排除结核病的必要性。
