在乌干达，使用 Xpert MTB/RIF 检测诊断为结核病的患者中，多方面干预措施改善治疗启动的可行性。

Feasibility of a multifaceted intervention to improve treatment initiation among patients diagnosed with TB using Xpert MTB/RIF testing in Uganda.

机构信息

The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.

Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America.

出版信息

PLoS One. 2022 Jun 17;17(6):e0265035. doi: 10.1371/journal.pone.0265035. eCollection 2022.

DOI:10.1371/journal.pone.0265035

PMID:35714072

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9491700/

Abstract

BACKGROUND

One in five patients diagnosed with TB in Uganda are not initiated on TB treatment within two weeks of diagnosis. We evaluated a multifaceted intervention for improving TB treatment initiation among patients diagnosed with TB using Xpert® MTB/RIF testing in Uganda.

METHODS

This was a pre-post interventional study at one tertiary referral hospital. The intervention was informed by the COM-B model and included; i) medical education sessions to improve healthcare worker knowledge about the magnitude and consequences of pretreatment loss to follow-up; ii) modified laboratory request forms to improve recording of patient contact information; and iii) re-designed workflow processes to improve timeliness of sputum testing and results dissemination. TB diagnostic process and outcome data were collected and compared from the period before (June to August 2019) and after (October to December 2019) intervention initiation.

RESULTS

In September 2019, four CME sessions were held at the hospital and were attended by 58 healthcare workers. During the study period, 1242 patients were evaluated by Xpert® MTB/RIF testing at the hospital (679 pre and 557 post intervention). Median turnaround time for sputum test results improved from 12 hours (IQR 4-46) in the pre-intervention period to 4 hours (IQR 3-6) in the post-intervention period. The proportion of patients started on treatment within two weeks of diagnosis improved from 59% (40/68) to 89% (49/55) (difference 30%, 95% CI 14%-43%, p<0.01) while the proportion of patients receiving a same-day diagnosis increased from 7.4% (5/68) to 25% (14/55) (difference 17.6%, 95% CI 3.9%-32.7%, p<0.01).

CONCLUSION

The multifaceted intervention was feasible and resulted in a higher proportion of patients initiating TB treatment within two weeks of diagnosis.

摘要

背景

在乌干达被诊断患有结核病的患者中，每五人就有一人在诊断后两周内未开始结核病治疗。我们评估了一种多方面的干预措施，以改善乌干达使用 Xpert® MTB/RIF 检测诊断为结核病的患者的结核病治疗启动率。

方法

这是一家三级转诊医院的前后干预研究。该干预措施以 COM-B 模型为指导，包括：i）医疗教育课程，以提高卫生保健工作者对治疗前失访的严重程度和后果的认识；ii）修改实验室申请表格，以提高患者联系信息的记录；iii）重新设计工作流程，以提高痰检的及时性和结果传播。收集并比较了干预措施启动前后（2019 年 6 月至 8 月和 2019 年 10 月至 12 月）的结核病诊断过程和结果数据。

结果

2019 年 9 月，在医院举行了四次 CME 会议，有 58 名卫生保健工作者参加。在研究期间，医院有 1242 名患者接受了 Xpert® MTB/RIF 检测（干预前 679 名，干预后 557 名）。痰检结果的周转时间中位数从干预前的 12 小时（IQR 4-46）改善到干预后的 4 小时（IQR 3-6）。在诊断后两周内开始治疗的患者比例从 59%（40/68）提高到 89%（49/55）（差异 30%，95%CI 14%-43%，p<0.01），而当天诊断的患者比例从 7.4%（5/68）提高到 25%（14/55）（差异 17.6%，95%CI 3.9%-32.7%，p<0.01）。