Department of Health and Emergency Services, Machakos County, Kenya.
Directorate of Research and Innovation, Mount Kenya University, Box 342-01000, Thika, Kenya.
Int Health. 2021 Apr 27;13(3):272-280. doi: 10.1093/inthealth/ihaa051.
Since 2016, patients with rifampicin-susceptible tuberculosis (TB) have been treated with the 6-month first-line regimen, regardless of treatment history. We assessed treatment outcomes of previously treated and new patients in Machakos subcounty, Kenya.
We performed a retrospective cohort study in patients started on first-line treatment between 2016 and 2017. Firth's logistic regression was used to estimate the effect of previous treatment on having a programmatic adverse outcome (either lost to follow-up, death, failure) and treatment failure vs treatment success (either cure or completion).
Of 1024 new and 79 previously treated patients, 88.1% and 74.7% were treated successfully, 6.5% and 7.6% died, 4.2% and 10.1% were lost to follow-up and 1.2% and 7.6% had treatment failure, respectively. Previous treatment predicted having a programmatic adverse outcome (adjusted odds ratio [aOR] 2.4 [95% confidence interval {CI} 1.4 to 4.2]) and treatment failure (aOR 7.3 [95% CI 2.6 to 20.4]) but not mortality. Similar correlations were found in 334 new and previously treated patients with confirmed baseline rifampicin susceptibility.
Previously treated patients were more at risk of experiencing a poor treatment outcome, mainly lost to follow-up and treatment failure. Adherence support may reduce lost to follow-up. Rifampicin drug susceptibility testing coverage should increase. More robust retreatment regimens may reduce treatment failure.
自 2016 年以来，无论治疗史如何，利福平敏感结核病（TB）患者均采用 6 个月的一线方案进行治疗。我们评估了肯尼亚 Machakos 次县既往治疗和新患者的治疗结局。
我们对 2016 年至 2017 年期间开始接受一线治疗的患者进行了回顾性队列研究。采用菲尔兹逻辑回归估计既往治疗对发生方案性不良结局（失访、死亡、失败）和治疗失败与治疗成功（治愈或完成）的影响。
在 1024 例新患者和 79 例既往治疗患者中，分别有 88.1%和 74.7%的患者治疗成功，6.5%和 7.6%的患者死亡，4.2%和 10.1%的患者失访，1.2%和 7.6%的患者治疗失败。既往治疗预测会发生方案性不良结局（校正比值比[aOR]2.4[95%置信区间{CI}1.4 至 4.2]）和治疗失败（aOR 7.3[95%CI 2.6 至 20.4]），但与死亡率无关。在 334 例基线利福平敏感性得到证实的新患者和既往治疗患者中也发现了类似的相关性。
既往治疗的患者更有可能出现不良治疗结局，主要是失访和治疗失败。加强治疗依从性支持可能会减少失访。利福平药敏检测覆盖率应提高。更有效的复治方案可能会降低治疗失败的风险。
