Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Behind KSSIDC Admin. Office, Rajajinagar, Bengaluru, Karnataka, 560044, India.
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
BMC Public Health. 2020 Jul 24;20(1):1158. doi: 10.1186/s12889-020-09257-5.
TB is a preventable and treatable disease. Yet, successful treatment outcomes at desired levels are elusive in many national TB programs, including India. We aim to identify risk factors for unfavourable outcomes to TB treatment, in order to subsequently design a care model that would improve treatment outcomes among these at-risk patients.
We conducted a cohort analysis among TB patients who had been recently initiated on treatment. The study was part of the internal program evaluation of a USAID-THALI project, implemented in select towns/cities of Karnataka and Telangana, south India. Community Health Workers (CHWs) under the project, used a pre-designed tool to assess TB patients for potential risks of an unfavourable outcome. CHWs followed up this cohort of patients until treatment outcomes were declared. We extracted treatment outcomes from patient's follow-up data and from the Nikshay portal. The specific cohort of patients included in our study were those whose risk was assessed during July and September, 2018, subsequent to conceptualisation, tool finalisation and CHW training. We used bivariate and multivariate logistic regression to assess each of the individual and combined risks against unfavourable outcomes; death alone, or death, lost to follow up and treatment failure, combined as 'unfavourable outcome'.
A significantly higher likelihood of death and experiencing unfavourable outcome was observed for individuals having more than one risk (AOR: 4.19; 95% CI: 2.47-7.11 for death; AOR 2.21; 95% CI: 1.56-3.12 for unfavourable outcome) or only one risk (AOR: 3.28; 95% CI: 2.11-5.10 for death; AOR 1.71; 95% CI: 1.29-2.26 for unfavourable outcome) as compared to TB patients with no identified risk. Male, a lower education status, an initial weight below the national median weight, co-existing HIV, previous history of treatment, drug-resistant TB, and regular alcohol use had significantly higher odds of death and unfavourable outcome, while age > 60 was only associated with higher odds of death.
A rapid risk assessment at treatment initiation can identify factors that are associated with unfavourable outcomes. TB programs could intensify care and support to these patients, in order to optimise treatment outcomes among TB patients.
结核病是一种可预防和可治疗的疾病。然而，在包括印度在内的许多国家结核病规划中，难以实现理想的治疗结果。我们旨在确定结核病治疗不良结局的风险因素，以便随后设计一种护理模式，从而改善这些高危患者的治疗结果。
我们对最近开始接受治疗的结核病患者进行了队列分析。该研究是美国国际开发署 THALI 项目内部方案评估的一部分，该项目在印度南部卡纳塔克邦和特伦甘纳邦的选定城镇/城市实施。该项目下的社区卫生工作者（CHWs）使用预先设计的工具来评估结核病患者发生不良结局的潜在风险。CHWs 对这组患者进行了随访，直到宣布治疗结果。我们从患者的随访数据和 Nikshay 门户中提取了治疗结果。我们研究中具体的患者队列包括那些在概念化、工具定稿和 CHW 培训后，于 2018 年 7 月和 9 月评估风险的患者。我们使用二变量和多变量逻辑回归来评估每个个体和综合风险与不良结局之间的关系；单独死亡或死亡、失访和治疗失败，合并为“不良结局”。
与没有发现风险的结核病患者相比，具有多种风险（比值比[OR]：4.19；95%置信区间[CI]：2.47-7.11 死亡；OR 2.21；95%CI：1.56-3.12 不良结局）或只有一种风险（OR：3.28；95%CI：2.11-5.10 死亡；OR 1.71；95%CI：1.29-2.26 不良结局）的个体，死亡和不良结局的可能性显著更高。男性、教育程度较低、初始体重低于国家中位数体重、合并 HIV、既往治疗史、耐药结核病和定期饮酒，与死亡和不良结局的可能性更高显著相关，而年龄＞60 岁仅与更高的死亡风险相关。
在治疗开始时进行快速风险评估，可以确定与不良结局相关的因素。结核病规划可以加强对这些患者的护理和支持，以优化结核病患者的治疗结果。
