Foster J'Belle, Mendez Diana, Marais Ben, Peniyamina Dunstan, McBryde Emma
College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Torres and Cape Tuberculosis Control Unit, Thursday Island, Queensland, Australia; and Australian Institute of Tropical Health and Medicine, Townsville, Queensland, Australia. Present address: College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
Australian Institute of Tropical Health and Medicine, Townsville, Queensland, Australia; Research & Academy Divisions and College of Public Health, Veterinary and Medical Science; and James Cook University, Townsville, Queensland, Australia
Rural Remote Health. 2023 Mar;23(1):7165. doi: 10.22605/RRH7165. Epub 2023 Mar 28.
Delays between self-reported symptom onset and commencement of effective treatment contribute to ongoing tuberculosis (TB) transmission, which is a particular concern in patients with drug-resistant (DR)-TB. The study authors assessed improvements in time to commencement of effective treatment in patients diagnosed with DR-TB in the Torres Strait-Papua New Guinea cross-border region.
All laboratory-confirmed DR-TB cases diagnosed in the Torres Strait between 1 March 2000 and 31 March 2020 were reviewed. Total time from self-reported onset of symptoms to effective treatment commencement in different programmatic time periods was assessed. Pairwise analyses and time to event proportional hazard calculations were used to explore the association between delays in median time to effective treatment, and selected variables. Data were further analysed to examine predictors of excessive treatment delay.
The median number of days from self-reported onset of symptoms to effective treatment commencement was 124 days (interquartile range 51-214) over two decades. Between 2006 and 2012, most (57%) cases exceeded this 'grand median' while the median 'time to treat' in the most recent time period (2016-2020) was significantly reduced to 29 days (p<0.001). Although there was a reduction in the median 'time to treat' with the introduction of Xpert MTB/RIF (135 days pre-Xpert v 67 days post-Xpert) this was not statistically significant (p=0.07). Establishment of the Torres and Cape TB Control Unit on Thursday Island (2016-2020) was significantly associated with reduced treatment delay, compared to the previous TB program period (2000-2005, p<0.04; 2006-2012, p<0.001).
Minimising TB treatment delay in remote settings like the Torres Strait-Papua New Guinea cross-border region requires effective decentralised diagnosis and management structures. The results of this study suggest that the establishment of the Torres and Cape TB Control Unit on Thursday Island significantly improved time to commencement of effective TB treatment. Possible contributing factors include better TB education, cross-border communication and patient-centred care.
自我报告症状出现到开始有效治疗之间的延迟会导致结核病（TB）持续传播，这在耐多药结核病（DR-TB）患者中尤为令人担忧。研究作者评估了托雷斯海峡-巴布亚新几内亚跨境地区确诊为耐多药结核病患者开始有效治疗时间的改善情况。
回顾了2000年3月1日至2020年3月31日期间在托雷斯海峡确诊的所有实验室确诊的耐多药结核病病例。评估了不同规划时间段内从自我报告症状出现到开始有效治疗的总时间。采用成对分析和事件发生时间比例风险计算来探讨有效治疗中位时间延迟与选定变量之间的关联。进一步分析数据以检查过度治疗延迟的预测因素。
二十年来，从自我报告症状出现到开始有效治疗的中位天数为124天（四分位间距51-214天）。在2006年至2012年期间，大多数（57%）病例超过了这个“总体中位数”，而最近时间段（2016-2020年）的中位“治疗时间”显著缩短至29天（p<0.001）。尽管引入Xpert MTB/RIF后中位“治疗时间”有所减少（Xpert之前为135天，之后为67天），但这在统计学上并不显著（p=0.07）。与之前的结核病规划期（2000-2005年，p<0.04；2006-2012年，p<0.001）相比，周四岛托雷斯和开普结核病控制单位的设立（2016-2020年）与治疗延迟的减少显著相关。
要在托雷斯海峡-巴布亚新几内亚跨境地区这样的偏远地区尽量减少结核病治疗延迟，需要有效的分散式诊断和管理结构。本研究结果表明，周四岛托雷斯和开普结核病控制单位的设立显著改善了开始有效结核病治疗的时间。可能的促成因素包括更好的结核病教育、跨境沟通和以患者为中心的护理。
