Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, McGill International TB Centre, Montreal, QC, Canada.
PATH, New Delhi, India.
Int J Tuberc Lung Dis. 2021 Sep 1;25(9):738-746. doi: 10.5588/ijtld.21.0266.
Half of India´s three million TB patients are treated in the largely unregulated private sector, where quality of care is often poor. Private provider interface agencies (PPIAs) seek to improve private sector quality of care, which can be measured in terms of case fatality and recurrence rates. We conducted a retrospective cohort survey of 4,000 private sector patients managed by the PATH PPIA between 2014 and 2017. We estimated treatment and post-treatment case-fatality ratios (CFRs) and recurrence rates. We used Cox proportional hazards models to identify predictors of fatality and recurrence. Patient loss to follow-up was adjusted for using selection weighting. The treatment CFR was 7.1% (95% CI 6.0-8.2). At 24 months post-treatment, the CFR was 2.4% (95% CI 1.7-3.0) and the recurrence rate was 1.9% (95% CI 1.3-2.5). Treatment fatality was associated with age (HR 1.02, 95% CI 1.02-1.03), clinical diagnosis (HR 0.61, 95% CI 0.45-0.84), treatment duration (HR 0.09, 95% CI 0.06-0.10) and adherence. Post-treatment fatality was associated with treatment duration (HR 0.87, 95% CI 0.79-0.91) and adherence. We found a moderate treatment phase CFR among PPIA-managed private sector patient with low rates of post-treatment fatality and recurrence. Routine monitoring of patient outcomes after treatment would strengthen PPIAs and inform future post TB interventions.
印度有 300 万结核病患者，其中一半在监管不严的私营部门接受治疗，而私营部门的医疗质量往往较差。私营提供者接口机构（PPIA）试图提高私营部门的医疗质量，可以通过病死率和复发率来衡量。我们对 PATH PPIA 在 2014 年至 2017 年期间管理的 4000 名私营部门患者进行了回顾性队列调查。我们估计了治疗和治疗后病死率（CFR）和复发率。我们使用 Cox 比例风险模型来确定病死率和复发的预测因素。使用选择加权来调整患者失访。治疗 CFR 为 7.1%（95%CI 6.0-8.2）。治疗后 24 个月，CFR 为 2.4%（95%CI 1.7-3.0），复发率为 1.9%（95%CI 1.3-2.5）。治疗病死率与年龄（HR 1.02，95%CI 1.02-1.03）、临床诊断（HR 0.61，95%CI 0.45-0.84）、治疗持续时间（HR 0.09，95%CI 0.06-0.10）和依从性有关。治疗后病死率与治疗持续时间（HR 0.87，95%CI 0.79-0.91）和依从性有关。我们发现，PPIA 管理的私营部门患者在治疗阶段病死率适中，治疗后病死率和复发率较低。对治疗后患者结局进行常规监测将加强 PPIA 并为未来的结核病后干预措施提供信息。
