Olupot Ben, Adrawa Norbert, Bajunirwe Francis, Izudi Jonathan
Institute of Public Health and Management (IPHM), Clarke International University (CIU), P.O. Box 7782, Kampala, Uganda.
The AIDS Support Organization (TASO), Center of Clinical Excellence, P.O. Box 347, Gulu, Uganda.
J Clin Tuberc Other Mycobact Dis. 2021 Mar 4;23:100226. doi: 10.1016/j.jctube.2021.100226. eCollection 2021 May.
Distance from residence to a health facility especially in rural areas presents a physical barrier and may influence tuberculosis (TB) treatment outcomes.
We examined the association between distance from residence to a health facility and TB treatment outcomes namely treatment success rate (TSR) and mortality, and whether HIV influences this relationship among people with TB in Kumi district in rural eastern Uganda.
In this cross-sectional design, we abstracted data from TB unit registers across four large health facilities. Travel of ≥5 km to a health facility was considered a long distance. The primary outcome was TSR and the secondary was mortality. We performed a generalized linear model with Poisson distribution with a log-link and robust standard errors to determine the association between distance and the study outcomes adjusting for potential confounders. We report the adjusted risk ratio (aRR) and 95% confidence interval (CI).
Of 611 participants studied, 484 (79.2%) were successfully treated, 18 (2.9%) died, and 359 (58.7%) travelled a long distance to access TB treatment. Long-distance was significantly associated with lower TSR (aRR, 0.93; 95% CI, 0.89-0.96). Further analysis showed that longer distance was associated with lower TSR among HIV positive persons with TB (aRR, 0.83; 95% CI, 0.72-0.96), but not among HIV negative persons with TB (aRR, 0.94; 95% CI, 0.85-1.03). Although it was not significant, longer distance showed a tendency towards worse mortality among HIV positive people with TB (aRR, 2.78; 95% CI, 0.80-9.66), but not among HIV negative people with HIV (aRR, 0.21; 0.03-1.74).
A majority of people with TB travel long distances to access treatment. Long distances are associated with lower TSR and higher mortality and affect people with TB who are HIV positive but not HIV negative. Interventions should focus on improving access to treatment for people with TB who travel long distances.
居住地与医疗机构之间的距离，尤其是在农村地区，构成了一个物理障碍，可能会影响结核病（TB）的治疗结果。
我们研究了居住地与医疗机构之间的距离与结核病治疗结果（即治疗成功率（TSR）和死亡率）之间的关联，以及在乌干达东部农村的库米区，艾滋病毒（HIV）是否会影响结核病患者之间的这种关系。
在这个横断面设计中，我们从四个大型医疗机构的结核病科室登记册中提取数据。前往医疗机构的距离≥5公里被视为远距离。主要结局是TSR，次要结局是死亡率。我们进行了一个具有泊松分布、对数链接和稳健标准误的广义线性模型，以确定距离与研究结局之间的关联，并对潜在混杂因素进行调整。我们报告调整后的风险比（aRR）和95%置信区间（CI）。
在611名研究参与者中，484人（79.2%）成功治愈，18人（2.9%）死亡，359人（58.7%）长途跋涉接受结核病治疗。远距离与较低的TSR显著相关（aRR，0.93；95%CI，0.89 - 0.96）。进一步分析表明，远距离与HIV阳性结核病患者较低的TSR相关（aRR，0.83；95%CI，0.72 - 0.96），但与HIV阴性结核病患者无关（aRR，0.94；95%CI，0.85 - 1.03）。虽然不显著，但远距离在HIV阳性结核病患者中显示出死亡率更差的趋势（aRR，2.78；95%CI，0.80 - 9.66），但在HIV阴性结核病患者中没有（aRR，0.21；0.03 - 1.74）。
大多数结核病患者长途跋涉接受治疗。远距离与较低的TSR和较高的死亡率相关，并且影响HIV阳性而非HIV阴性的结核病患者。干预措施应侧重于改善长途跋涉的结核病患者获得治疗的机会。
