John Snow India (JSI), Tuberculosis Health Action and Learning Initiative (THALI), West Bengal.
Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris.
Monaldi Arch Chest Dis. 2021 Feb 2;91(1). doi: 10.4081/monaldi.2021.1555.
In India, an estimated 50% of tuberculosis (TB) patients are diagnosed and managed by private providers (PPs). However, there is limited information on treatment outcomes among those treated by PPs largely because of a lack of systems for patient follow-up and documentation of the outcomes. Tuberculosis Health Action Learning Initiative (THALI) project implemented in six districts of West Bengal, supported PPs in managing TB patients and systematically documented the TB treatment outcomes of such patients. This provided us an opportunity to describe the treatment outcomes and assess factors associated with 'unsuccessful outcomes' among TB patients notified by PPs from January to April 2018. This was a retrospective cohort study using routinely collected data. During the study reference period, 2347 patients were notified from 389 PPs. The patient's mean (SD) age was 39.9 (17.2) years and 61% were males. Of the total, about 86% had pulmonary TB, 95% were new cases, and 23% were microbiologically confirmed (either on sputum smear microscopy or Xpert assay). Among 2347 patients, 19% received free drugs from the National Tuberculosis Program (NTP) under the supervision of PPs while the rest purchased anti-TB drugs from the private pharmacies. The 'successful outcomes' (cured and treatment completed) were seen in 86.1% (95% confidence interval (CI), 84.6%-87.4%) patients and 8.6% were 'not evaluated'. The patients who received free NTP drugs (adjusted relative risk-4.0 (95% CI: 3.1-5.0)) had a higher risk of 'unsuccessful outcomes' than those who availed of drugs from private pharmacies. The high 'successful outcomes' among TB patients treated by PPs are promising. However, higher 'unsuccessful outcomes' among patients on free NTP drugs need to be explored, and suitable corrective actions have to be taken.
在印度，约有 50%的结核病（TB）患者由私人提供者（PPs）诊断和管理。然而，由于缺乏对患者进行随访和记录治疗结果的系统，关于这些患者的治疗结果的信息有限。结核病健康行动学习倡议（THALI）项目在西孟加拉邦的六个地区实施，该项目支持 PPs 管理结核病患者，并系统地记录这些患者的结核病治疗结果。这为我们提供了一个机会，描述了 2018 年 1 月至 4 月由 PPs 报告的结核病患者的治疗结果，并评估了与这些患者“治疗失败”相关的因素。这是一项回顾性队列研究，使用常规收集的数据。在研究参考期内，有 389 名 PPs 报告了 2347 名患者。患者的平均（SD）年龄为 39.9（17.2）岁，61%为男性。在总数中，约 86%患有肺结核，95%为新发病例，23%为微生物学确诊（痰涂片显微镜检查或 Xpert 检测）。在 2347 名患者中，19%的人在 PPs 的监督下从国家结核病规划（NTP）获得免费药物，而其余的人则从私人药店购买抗结核药物。86.1%（95%置信区间（CI），84.6%-87.4%）的患者取得了“成功治疗结果”（治愈和治疗完成），8.6%的患者“未评估”。与使用私人药店购买药物的患者相比，使用 NTP 免费药物的患者（调整后的相对风险为 4.0（95%CI：3.1-5.0））治疗失败的风险更高。在 PPs 治疗的结核病患者中取得的高“成功治疗结果”是令人鼓舞的。然而，需要进一步探讨 NTP 免费药物治疗的患者中较高的“治疗失败”率，并采取适当的纠正措施。
