Interactive Research and Development, 4th floor, Woodcraft Building, Plot No. 3 & 3-A, Sector 47, Korangi Creek Road, Karachi 75190, Pakistan.
Indus Hospital and Health Network, Plot C-76, Sector 31/5, Korangi, Karachi 75190, Pakistan.
Health Policy Plan. 2022 Sep 13;37(8):979-989. doi: 10.1093/heapol/czac038.
Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models-made increasingly urgent by the COVID-19 pandemic-are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005-1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential.
在耐多药结核病（DR-TB）负担沉重的国家，分散的、以患者为中心的护理模式继续资源不足。在 COVID-19 大流行的情况下，实施这些模式对于解决 DR-TB 护理方面的差距至关重要。我们从 2010 年至 2017 年在巴基斯坦信德省和俾路支省的 11 个机构中对开始治疗的利福平耐药（RR）/耐多药结核病（MDR-TB）患者的数据进行了抽象。我们分析了与向城市周边和农村地区扩大方案有关的治疗结果趋势，并估计了从患者居住地到治疗机构的行车距离。在分析的 5586 名 RR/MDR-TB 患者中，随着方案的扩大，总体治疗成功率从 2010 年的 82%下降到 2017 年的 66%。对于每增加 20 公里的行车距离，不良结果的调整风险比为 1.013（95%置信区间 1.005-1.021）。我们的分析表明，将 DR-TB 护理扩展到集中枢纽，为在城市周边和农村地区接受护理的人增加了不良结果的风险。我们提出，随着登记人数的增加，在受影响社区附近或内部扩大 DR-TB 服务至关重要。
