Universidad María Auxiliadora, Lima, Peru.
Wayne State University School of Medicine, Detroit, MI, USA.
Infect Dis Poverty. 2021 May 7;10(1):63. doi: 10.1186/s40249-021-00845-0.
Tuberculosis (TB) prevention through the use of preventive treatment is a critical activity in the elimination of TB. In multiple settings, limited staffing has been identified as a barrier to managing preventive treatment for TB contacts. This study aims to determine how health center staffing, service type, and TB caseload affects implementation of isoniazid preventive therapy (IPT) for TB contacts in southern Lima.
We conducted an ecological study in 2019 in southern Lima, Peru. Through the review of medical records, we identified contacts of TB patients who initiated IPT during 2016-2018, and who were 0-19 years old, the age group eligible for IPT according to Peruvian guidelines. We assessed bivariate associations between health center characteristics (numbers of physicians and nurses, types of services available, annual TB caseload) and IPT initiation and completion using binomial logistic regression.
Among 977 contacts, 69% took more than a week to start IPT and 41% did not complete IPT. For those who successfully completed IPT, 58% did not complete full medical follow-up. There was no significant difference in IPT completion or adherence based on whether health centers had more physicians and nurses, more comprehensive services, or higher TB caseloads. Among contacts, female sex was associated with delay in initiating IPT (P = 0.005), age 5-19 years old was associated with completion of IPT (P = 0.025) and age < 5 years old was associated with completion of clinical evaluations (P = 0.041).
There are significant gaps in IPT implementation in health centers of southern Lima, Peru, but insufficient staffing of health centers may not be responsible. Further research is needed to identify how IPT implementation can be improved, potentially through improving staff training or monitoring and supervision.
通过使用预防性治疗来预防结核病是消除结核病的关键活动。在多个环境中，人员配备有限已被确定为管理结核病接触者预防性治疗的障碍。本研究旨在确定卫生中心人员配备、服务类型和结核病病例数如何影响秘鲁利马南部结核病接触者异烟肼预防性治疗 (IPT) 的实施。
我们于 2019 年在秘鲁利马南部进行了一项生态学研究。通过审查病历，我们确定了在 2016-2018 年期间开始接受 IPT 的结核病患者的接触者，这些接触者年龄在 0-19 岁之间，根据秘鲁指南，该年龄组有资格接受 IPT。我们使用二项逻辑回归评估了卫生中心特征（医生和护士人数、提供的服务类型、年结核病病例数）与 IPT 启动和完成之间的二变量关联。
在 977 名接触者中，69%的人超过一周才开始接受 IPT，41%的人没有完成 IPT。对于成功完成 IPT 的人，58%的人没有完成完整的医疗随访。卫生中心是否有更多的医生和护士、更全面的服务或更高的结核病病例数，与 IPT 完成率或依从性没有显著差异。在接触者中，女性性别与 IPT 启动延迟有关（P=0.005），5-19 岁年龄与 IPT 完成有关（P=0.025），年龄<5 岁与临床评估完成有关（P=0.041）。
秘鲁利马南部卫生中心的 IPT 实施存在重大差距，但卫生中心人员配备不足可能不是原因。需要进一步研究以确定如何改进 IPT 的实施，可能通过改进员工培训或监测和监督来实现。
