每日自我治疗和每周三次直接观察治疗在两个新诊断、痰阳性的肺结核成人队列中的治疗结果。

Treatment outcomes with daily self-administered treatment and thrice-weekly directly-observed treatment in two cohorts of newly-diagnosed, sputum-positive adults with pulmonary tuberculosis.

机构信息

Post Graduate Resident, Community Health Department, Christian Medical College, Vellore 632002, Tamil Nadu, India.

Professor & Director, B. V. Moses Centre for Evidence-Informed Health Care & Health Policy, Christian Medical College, Vellore, India.

出版信息

Indian J Tuberc. 2020 Jan;67(1):105-111. doi: 10.1016/j.ijtb.2017.05.012. Epub 2017 Jun 24.

DOI:10.1016/j.ijtb.2017.05.012

PMID:32192603

Abstract

BACKGROUND

The Revised National Tuberculosis Control Program (RNTCP) envisages shifting from thrice-weekly to a daily anti-tuberculosis treatment (ATT) regimen. The potential merits and demerits of both regimens continue to be debated.

METHODS

This retrospective study compared treatment outcomes in 191 HIV-negative, newly diagnosed, sputum-positive adults with pulmonary tuberculosis from Vellore district of Tamil Nadu who were treated at a private medical college during 2009 to 2012 with intermittent Directly Observed Treatment Short Course (intermittent DOTS cohort, n=132) or who opted for daily Self-Administered Treatment (daily SAT cohort, n=59). Treatment outcomes obtained from medical records were supplemented by interviews with consenting, traceable patients.

RESULTS

The rates for the RNTCP-recommended sputum smear examinations were suboptimal (42% for daily SAT and 72% for intermittent DOTS). However, treatment success with daily SAT and intermittent DOTS (76.2% vs. 70.4%); default (11.9% vs. 18.2%); death (6.8% vs. 5.3%); treatment failure (5.1% vs. 4.6%); and relapse (0% vs. 1.5%) did not significantly differ.

CONCLUSIONS

While evaluable treatment outcomes were not significantly different with daily SAT and intermittent DOTS, rates for timely smear examinations and for treatment success were lower, and for default higher, in both cohorts than comparable RNTCP data from Vellore district. Further strengthening of RNTCP facilities within private medical colleges and regular, real-time audits of performance and outcomes are needed if daily ATT regimen under the RNTCP is to succeed.

摘要

背景

修订后的国家结核病控制规划（RNTCP）设想将每周三次的抗结核治疗（ATT）方案改为每日方案。两种方案的潜在优缺点仍在争论中。

方法

这项回顾性研究比较了来自泰米尔纳德邦维洛尔区的 191 名 HIV 阴性、新诊断、痰阳性的肺结核成人在 2009 年至 2012 年期间在一所私立医学院接受治疗的结果，他们接受的治疗是间歇性直接观察治疗短程化疗（间歇性 DOTS 队列，n=132）或选择每日自我管理治疗（每日 SAT 队列，n=59）。从病历中获得的治疗结果通过对同意并可追踪的患者进行访谈进行了补充。

结果

RNTCP 推荐的痰涂片检查率不理想（每日 SAT 为 42%，间歇性 DOTS 为 72%）。然而，每日 SAT 和间歇性 DOTS 的治疗成功率（76.2%对 70.4%）、停药（11.9%对 18.2%）、死亡（6.8%对 5.3%）、治疗失败（5.1%对 4.6%）和复发（0%对 1.5%）并无显著差异。

结论

虽然每日 SAT 和间歇性 DOTS 的可评估治疗结果没有显著差异，但无论是在每日 SAT 组还是在间歇性 DOTS 组，及时进行痰涂片检查和治疗成功率都较低，停药率较高，这两个队列的数据均低于维洛尔区 RNTCP 的可比数据。如果要使 RNTCP 下的每日 ATT 方案成功，就需要在私立医学院内进一步加强 RNTCP 设施，并定期对绩效和结果进行实时审计。