du Preez K, Schaaf H S, Dunbar R, Swartz A, Naidoo P, Hesseling A C
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Paediatrics and Child Health, Tygerberg Hospital, Cape Town, South Africa.
Public Health Action. 2020 Mar 21;10(1):38-46. doi: 10.5588/pha.19.0053.
A referral hospital in Cape Town, Western Cape Province, Republic of South Africa.
To measure the impact of a hospital-based referral service (intervention) to reduce initial loss to follow-up among children with tuberculosis (TB) and ensure the completeness of routine TB surveillance data.
A dedicated TB referral service was established in the paediatric wards at Tygerberg Hospital, Cape Town, in 2012. Allocated personnel provided TB education and counselling, TB referral support and weekly telephonic follow-up after hospital discharge. All children identified with TB were matched to electronic TB treatment registers (ETR.Net/EDRWeb). Multivariable logistic regression was used to compare reporting of culture-confirmed and drug-susceptible TB cases before (2007-2009) and during (2012) the intervention.
Successful referral with linkage to care was confirmed in 267/272 (98%) and successful reporting in 227/272 (84%) children. Children with drug-susceptible, culture-confirmed TB were significantly more likely to be reported during the intervention period than in the pre-intervention period (OR 2.52, 95%CI 1.33-4.77). The intervention effect remained consistent in multivariable analysis (adjusted OR 2.62; 95%CI 1.31-5.25) after adjusting for age, sex, human immunodeficiency virus status and the presence of TB meningitis.
A simple hospital-based TB referral service can reduce initial loss to follow-up and improve recording and reporting of childhood TB in settings with decentralised TB services.
南非共和国西开普省开普敦的一家转诊医院。
评估一项基于医院的转诊服务（干预措施）对减少结核病（TB）患儿初次失访的影响，并确保常规结核病监测数据的完整性。
2012年在开普敦泰格伯格医院的儿科病房设立了专门的结核病转诊服务。分配的工作人员提供结核病教育和咨询、结核病转诊支持以及出院后每周的电话随访。所有确诊为结核病的儿童都与电子结核病治疗登记册（ETR.Net/EDRWeb）进行匹配。采用多变量逻辑回归比较干预前（2007 - 2009年）和干预期间（2012年）培养确诊且药敏结核病病例的报告情况。
272名儿童中有267名（98%）成功转诊并与医疗服务建立联系，227名（84%）成功报告。药敏培养确诊的结核病患儿在干预期间比干预前期更有可能被报告（比值比2.52，95%置信区间1.33 - 4.77）。在对年龄、性别、人类免疫缺陷病毒感染状况和结核性脑膜炎的存在进行调整后，多变量分析中干预效果仍然一致（调整后比值比2.62；95%置信区间1.31 - 5.25）。
一项简单的基于医院的结核病转诊服务可以减少初次失访，并改善结核病服务分散地区儿童结核病的记录和报告。
