Institute for Global Health, University College London, London, UK.
Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot Tak, Thailand.
Int J Tuberc Lung Dis. 2020 Oct 1;24(10):1009-1015. doi: 10.5588/ijtld.20.0014.
Cross-border migrants at the Thailand-Myanmar border are an underserved and vulnerable population. We aimed to identify the causes and risk factors for TB mortality at a migrant-friendly TB programme. Routinely collected data on TB cases, treatment outcomes and causes of death were analysed for adult TB cases diagnosed between January 2013 and April 2017. Mortality in the 6 months post-diagnosis was calculated and risk factors were identified using multivariable Poisson regression. Of the 1344 TB cases diagnosed, 1005 started treatment and 128 died. Case fatality rate was 9.5% and the TB mortality rate was 2.4/100 person-months. The number of pre-treatment deaths (33/128) and losses to follow-up (9.0%) were high. Among cases enrolled in treatment, the treatment success rate was 79.8%. When stratified by HIV status, case fatality was higher in HIV-positive cases not on antiretroviral therapy (ART) (90.3%) or with unknown HIV status (31.8%) than those on ART (14.3%) or HIV-negative (8.6%). This TB programme achieved high treatment success rates in a population with a substantial burden of TB-HIV coinfection. Expanding access to HIV testing and ART is crucial to reduce mortality. Striving towards same-day TB diagnosis and treatment could reduce death and loss to follow-up.
中缅边境的跨境移民是一个服务不足和脆弱的群体。我们旨在确定在一个对移民友好的结核病规划中结核病死亡率的原因和风险因素。对 2013 年 1 月至 2017 年 4 月期间诊断的成人结核病病例的结核病病例、治疗结果和死因的常规收集数据进行了分析。计算了诊断后 6 个月的死亡率，并使用多变量泊松回归确定了风险因素。在诊断的 1344 例结核病病例中，1005 例开始治疗，128 例死亡。病死率为 9.5%，结核病死亡率为 2.4/100 人月。治疗前死亡人数（33/128）和失访人数（9.0%）较高。在接受治疗的病例中，治疗成功率为 79.8%。按 HIV 状况分层，未接受抗逆转录病毒治疗（ART）或 HIV 状况未知的 HIV 阳性病例（90.3%）或 HIV 阴性病例（8.6%）的病死率高于接受 ART 或 HIV 阴性病例（14.3%）。该结核病规划在结核病 - 艾滋病毒合并感染负担较重的人群中实现了较高的治疗成功率。扩大艾滋病毒检测和 ART 的获取途径对于降低死亡率至关重要。努力实现结核病当天诊断和治疗可减少死亡和失访。
