Bezerra Wanessa da Silva Peres, Lemos Everton Ferreira, do Prado Thiago Nascimento, Kayano Larissa Taemy, Zacarin de Souza Stefany, Chaves Cláudia Elizabeth Volpe, Paniago Anamaria Mello Miranda, de Souza Albert Schiaveto, de Oliveira Sandra Maria do Valle Leone
Postgraduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
Patient Prefer Adherence. 2020 Dec 3;14:2389-2397. doi: 10.2147/PPA.S266475. eCollection 2020.
To study the factors associated with the risk of discontinuing active tuberculosis treatment among patients in an outpatient referral unit and to analyze the association between patients' abandonment risk score and their odds of discontinuing the treatment.
In this cohort study, tuberculosis patients were prospectively followed up from June 2012 through July 2019 at a secondary tuberculosis referral unit in Mato Grosso do Sul, Brazil. At initial consultation, patients were interviewed using a standardized questionnaire and were assigned a score for the risk of treatment abandonment by the nurse. Univariate and multivariate analyses were performed using logistic regression.
One hundred and forty-eight patients were included in the study, of which 65.0% (96/148) were male. Their mean age was 43.3 ± 14.8 years (range: 18-89 years). Smoking, drug use, repeated admissions, and a high abandonment risk score were the variables associated with the highest risk of discontinuing the treatment. The rate of tuberculosis and human immunodeficiency virus coinfection was 37.2%. The overall rate of global treatment abandonment was 10.8% (95% confidence interval [CI]: 6.1-16.2). Upon stratification of patients that abandoned by the risk score, 22.9% (8/35) of the ones that abandoned had a high risk, 10.9% (6/55) had an intermediate risk, and 3.5% (2/58) had a low risk of treatment abandonment. In multivariate analysis, the factors associated with abandoning the treatment were smoking [adjusted odds ratio (aOR) = 4.91 (95% CI: 1.08, 22.32)] and undergoing retreatment (aOR) = 3.66 (95% CI: 1.04, 12 88).
Smoking and undergoing retreatment were independent risk factors for tuberculosis treatment abandonment in this center. Risk stratification can help prioritize the strengthening of treatment adherence among patients at higher risk of abandoning treatment in referral units.
研究门诊转诊单位中与中断活动性结核病治疗风险相关的因素，并分析患者的放弃治疗风险评分与其中断治疗几率之间的关联。
在这项队列研究中，于2012年6月至2019年7月对巴西南马托格罗索州一家二级结核病转诊单位的结核病患者进行了前瞻性随访。在初次会诊时，使用标准化问卷对患者进行访谈，并由护士为其治疗放弃风险打分。采用逻辑回归进行单因素和多因素分析。
148名患者纳入研究，其中65.0%（96/148）为男性。他们的平均年龄为43.3±14.8岁（范围：18 - 89岁）。吸烟、吸毒、反复入院以及高放弃风险评分是与中断治疗风险最高相关的变量。结核病与人类免疫缺陷病毒合并感染率为37.2%。总体治疗放弃率为10.8%（95%置信区间[CI]：6.1 - 16.2）。根据风险评分对放弃治疗的患者进行分层后，放弃治疗的患者中22.9%（8/35）为高风险，10.9%（6/55）为中度风险，3.5%（2/58）为低风险。在多因素分析中，与放弃治疗相关的因素为吸烟[调整后的优势比（aOR）= 4.91（95% CI：1.08，22.32）]和接受再次治疗（aOR）= 3.66（95% CI：1.04，12.88）。
在该中心，吸烟和接受再次治疗是结核病治疗放弃的独立危险因素。风险分层有助于在转诊单位中对放弃治疗风险较高的患者加强治疗依从性进行优先排序。
