乌干达两家转诊医院耐多药结核病治疗患者报告不良事件的流行情况及相关因素。
Prevalence and factors associated with reported adverse-events among patients on multi-drug-resistant tuberculosis treatment in two referral hospitals in Uganda.
机构信息
College of Health Sciences School of Public Health, Makerere University, Kampala, Uganda.
Makerere University Center for Health and Population Research, Kampala, Uganda.
出版信息
BMC Infect Dis. 2023 Mar 10;23(1):149. doi: 10.1186/s12879-023-08085-3.
BACKGROUND
Multi-drug-resistant tuberculosis (MDR-TB) treatment involves toxic drugs that cause adverse events (AEs), which are life-threatening and may lead to death if not well managed. In Uganda, the prevalence of MDR-TB is increasingly high, and about 95% of the patients are on treatment. However, little is known about the prevalence of AEs among patients on MDR-TB medicines. We therefore estimated the prevalence of reported adverse events (AEs) of MDR-TB drugs and factors associated with AEs in two health facilities in Uganda.
METHODS
A retrospective cohort study of MDR-TB was conducted among patients enrolled at Mulago National Referral and Mbarara Regional Referral hospitals in Uganda. Medical records of MDR-TB patients enrolled between January 2015 and December 2020 were reviewed. Data on AEs, which were defined as irritative reactions to MDR-TB drugs, were extracted and analyzed. To describe reported AEs, descriptive statistics were computed. A modified Poisson regression analysis was used to determine factors associated with reported AEs.
RESULTS
Overall, 369 (43.1%) of 856 patients had AEs, and 145 (17%) of 856 had more than one. Joint pain (244/369, or 66%), hearing loss (75/369, or 20%), and vomiting (58/369, or 16%) were the most frequently reported effects. Patients started on the 24-month regimen (adj. PR = 1.4, 95%; 1.07, 1.76) and individualized regimens (adj. PR = 1.5, 95%; 1.11, 1.93) were more likely to suffer from AEs. Lack of transport for clinical monitoring (adj. PR = 1.9, 95%; 1.21, 3.11); alcohol consumption (adj. PR = 1.2, 95%; 1.05, 1.43); and receipt of directly observed therapy from peripheral health facilities (adj. PR = 1.6, 95%; 1.10, 2.41) were significantly associated with experiencing AEs. However, patients who received food supplies (adj. PR = 0.61, 95%; 0.51, 0.71) were less likely to suffer from AEs.
CONCLUSION
The frequency of adverse events reported by MDR-TB patients is considerably high, with joint pain being the most common. Interventions such as the provision of food supplies, transportation, and consistent counseling on alcohol consumption to patients at initiation treatment facilities may contribute to a reduction in the rate of occurrence of AEs.
背景
耐多药结核病（MDR-TB）的治疗涉及到具有毒性的药物，这些药物会引起不良反应（AEs），如果管理不当，这些不良反应可能危及生命，甚至导致死亡。在乌干达，MDR-TB 的患病率越来越高，约 95%的患者正在接受治疗。然而，我们对于 MDR-TB 药物治疗患者的不良反应（AEs）的流行情况知之甚少。因此，我们评估了在乌干达的两家医疗机构中，报告的 MDR-TB 药物不良反应（AEs）的患病率，以及与 AEs 相关的因素。
方法
对乌干达马加迪国家转诊和姆巴拉拉地区转诊医院的 MDR-TB 患者进行了回顾性队列研究。回顾了 2015 年 1 月至 2020 年 12 月期间登记的 MDR-TB 患者的病历。提取并分析了定义为对 MDR-TB 药物的刺激性反应的 AEs 数据。为了描述报告的 AEs，进行了描述性统计分析。使用修正泊松回归分析来确定与报告的 AEs 相关的因素。
结果
总体而言，856 名患者中有 369 名（43.1%）出现了 AEs，856 名患者中有 145 名（17%）出现了不止一种 AEs。最常报告的影响是关节痛（244/369，或 66%）、听力损失（75/369，或 20%）和呕吐（58/369，或 16%）。开始使用 24 个月方案（调整后的 PR=1.4，95%；1.07，1.76）和个体化方案（调整后的 PR=1.5，95%；1.11，1.93）的患者更有可能出现 AEs。缺乏用于临床监测的交通工具（调整后的 PR=1.9，95%；1.21，3.11）；饮酒（调整后的 PR=1.2，95%；1.05，1.43）；以及从外围卫生机构接受直接观察治疗（调整后的 PR=1.6，95%；1.10，2.41）与出现 AEs 显著相关。然而，接受食物供应的患者（调整后的 PR=0.61，95%；0.51，0.71）不太可能出现 AEs。
结论
MDR-TB 患者报告的不良反应频率相当高，以关节痛最为常见。在启动治疗设施时向患者提供食物供应、交通以及持续的酒精使用咨询等干预措施，可能有助于降低不良反应的发生率。
Zotero 插件