结核病患者的治疗启动：短信息服务 (SMS) 技术和基于病房的外展团队 (WBOTs) 的作用。

Treatment initiation among tuberculosis patients: the role of short message service (SMS) technology and Ward-based outreach teams (WBOTs).

机构信息

Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.

Centre for Tuberculosis, National Institute of Communicable Diseases, Johannesburg, South Africa.

出版信息

BMC Public Health. 2022 Feb 15;22(1):318. doi: 10.1186/s12889-022-12736-6.

DOI:10.1186/s12889-022-12736-6

PMID:35168581

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8848795/

Abstract

BACKGROUND

In South Africa, tuberculosis (TB) is a public health problem with treatment initiation failure rates varying between 14.9 and 25%. Lack of proper provider/patient communication on next steps after testing, not being aware that results are ready; and other competing priorities are some of the reasons for this failure. We aimed to assess the effectiveness of Short Message Service (SMS) technology and ward-based outreach teams (WBOTs) in improving TB treatment initiation. A 3-arm randomized controlled trial (Standard of care-SOC, SMS technology or WBOTs) was conducted between September 2018 and April 2020. Newly diagnosed TB patients randomly allocated to SMS and WBOTs groups were sent reminder messages (text message or paper slip respectively) that results were ready. Due to unforeseen challenges (financial and impact of the COVID 19 pandemic), implementation was only in two of the eight clinics planned.

RESULTS

314 TB patients were assigned to one of three groups (SOC = 104, WBOTs = 105, and SMS = 105). Chi-square tests were used to compare proportions starting treatment (primary outcome). More patients in the SMS group (92/105; 88%) initiated treatment than in the SOC group (81/104; 78%), although this difference did not reach statistical significance (P = 0.062). The time to treatment initiation was significantly shorter in the SMS group than in the SOC group (P < 0.001). The proportions of patients initiated on treatment in the WBOTs group (45/62; 73%) and in the SOC group (44/61; 72%) were similar (P = 0.956). The times to treatment initiation for these two groups were also similar. The 3 group analysis yielded similar proportions initiated on treatment (P = 0.048 for SMS/SOC comparison and P = 0.956 for WBOTs/SOC comparison) but analysis of times to treatment initiation yielded some variations.

CONCLUSION

Reminder SMS messages sent to newly diagnosed TB patients improved the time to treatment initiation. Further research is required to show effect of the WBOTs intervention.

TRIAL REGISTRATION

Retrospectively registered with the Pan African Clinical Trial Registry ( PACTR202101914895981 ). The trial was registered with the Pan African Clinical Trial Registry on 25 January, 2021 (ref: PACTR202101914895981 ; https://pactr.samrc.ac.za ). The registration was retrospective due to an oversight. Nevertheless, the protocol details outlined in our ethics application were strictly adhered to.

摘要

背景

在南非，结核病（TB）是一个公共卫生问题，治疗启动失败率在 14.9%至 25%之间。检测后缺乏适当的医患沟通下一步措施，不知道结果已准备好；以及其他竞争优先事项是导致这种失败的一些原因。我们旨在评估短信息服务（SMS）技术和病房外展团队（WBOTs）在提高结核病治疗启动方面的有效性。一项 3 臂随机对照试验（标准护理-SOC、SMS 技术或 WBOTs）于 2018 年 9 月至 2020 年 4 月期间进行。新诊断的结核病患者随机分配到 SMS 和 WBOTs 组，他们会收到通知消息（短信或纸条），告知结果已准备好。由于不可预见的挑战（财务和 COVID-19 大流行的影响），仅在计划的 8 个诊所中的 2 个实施。

结果

314 例结核病患者被分配到三个组之一（SOC=104，WBOTs=105，SMS=105）。卡方检验用于比较开始治疗的比例（主要结局）。SMS 组中开始治疗的患者比例（92/105；88%）高于 SOC 组（81/104；78%），尽管这一差异没有达到统计学意义（P=0.062）。SMS 组的治疗启动时间明显短于 SOC 组（P<0.001）。WBOTs 组（45/62；73%）和 SOC 组（44/61；72%）开始治疗的患者比例相似（P=0.956）。这两组的治疗启动时间也相似。3 组分析得出的开始治疗比例相似（SMS/SOC 比较 P=0.048，WBOTs/SOC 比较 P=0.956），但治疗启动时间分析结果存在一些差异。