National Center for Disease Control and Public Health, Tbilisi.
Tuberculosis Research and Prevention Center NGO, Yerevan.
Monaldi Arch Chest Dis. 2021 Jan 14;91(1). doi: 10.4081/monaldi.2021.1705.
Despite having universal access to tuberculosis (TB) treatment, loss to follow-up (LFU) rates remain high in Georgia, 6% among drug-susceptible TB (DS-TB) patients (2017 cohort) and 19% among drug-resistant TB (DR-TB) patients diagnosed in 2016. A cohort study was conducted to analyze secondary data from the Georgian National Tuberculosis Surveillance Database. Study population included adult (≥18 y.o.) patients with bacteriologically confirmed pulmonary TB who were enrolled in Georgian National TB program during 2015-2017. The outcome of interest was loss to follow-up, defined as treatment interruption for more than 2 consecutive months. Patients were stratified by treatment profile (first-line drugs or second-line drugs) and survival analysis was performed within the stratified groups. A total of 7860 treatment episodes were identified during 2015-2017 which corresponded to 6696 bacteriologically confirmed pulmonary TB treatment episodes of whom 795 (12%) were LFU. After adjustment, final multivariate analysis showed that male sex (aHR 1.5, 95%CI 1.2-2.0), being diagnosed in Tbilisi (aHR 1.3, 95%CI 1.1-1.6), unemployment at the time of diagnosis (aHR 1.7, 95%Ci 1.2-2.3) and previous history of TB treatment were independent risk factors for LFU (aHR 2.3, 95%CI 1.9-2.8) among patients on first-line drugs. Among patients on second-line drugs being male (aHR 2.0, 95%CI 1.2-3.2), past TB treatment with second-line drugs (aHR 2.2, 95%CI 1.5-3.2) were significantly associated with LFU. LFU rate was high among patients on first-line drugs and second line drugs (10% and 22% respectively). Patients with past TB treatment history should further research to identify factors that lead to treatment interruption in this group. Other factors associated with LFU (being internally displaced person (IDP), being unemployed, and having imprisonment history) were in some level indication of a poor social-economic status, and strengthening approaches for TB care based on patients' need could be considered in light of this finding.
尽管格鲁吉亚已经普及了结核病（TB）治疗，但失访（LFU）率仍然很高，耐多药结核病（DR-TB）患者为 19%（2016 年确诊），药物敏感结核病（DS-TB）患者为 6%（2017 年确诊）。本研究对格鲁吉亚国家结核病监测数据库中的二级数据进行了分析。研究人群包括 2015 年至 2017 年期间在格鲁吉亚国家结核病规划中登记的患有经细菌学证实的肺 TB 的成年（≥18 岁）患者。感兴趣的结局是失访，定义为连续两个月以上中断治疗。根据治疗方案（一线药物或二线药物）对患者进行分层，并在分层组内进行生存分析。2015 年至 2017 年期间共发现 7860 个治疗期，对应 6696 例经细菌学证实的肺 TB 治疗期，其中 795 例（12%）失访。调整后，最终多变量分析显示，男性（aHR 1.5，95%CI 1.2-2.0）、在第比利斯诊断（aHR 1.3，95%CI 1.1-1.6）、诊断时失业（aHR 1.7，95%CI 1.2-2.3）和既往结核病治疗史是一线药物治疗患者发生 LFU 的独立危险因素（aHR 2.3，95%CI 1.9-2.8）。二线药物治疗的患者中，男性（aHR 2.0，95%CI 1.2-3.2）和既往二线药物治疗（aHR 2.2，95%CI 1.5-3.2）与 LFU 显著相关。一线药物和二线药物治疗患者的 LFU 率分别为 10%和 22%。有既往结核病治疗史的患者应进一步研究，以确定导致该组患者治疗中断的因素。与 LFU 相关的其他因素（境内流离失所者（IDP）、失业和有监禁史）在一定程度上表明社会经济地位较差，根据这一发现，可以考虑基于患者需求加强结核病护理方法。
