Kurbaniyazova G, Msibi F, Bogati H, Kal M, Sofa A, Abdi Djama E, Mozi P, Hossain F, Blasco P, Sannino L
Médecins San Frontières (MSF), Paris, France.
National Tuberculosis Programme, Papua New Guinea.
Public Health Action. 2023 Jun 21;13(2):60-64. doi: 10.5588/pha.22.0062.
Papua New Guinea (PNG) has one of the world's highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary.
To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context.
A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019-2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model.
Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7-19.3), as were PEC sessions (OR 4.3, 95% CI 2.5-7.2).
By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals' needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.
巴布亚新几内亚（PNG）是世界上结核病发病率最高的国家之一。由于基础设施不足和地形复杂，偏远省份的患者难以获得结核病治疗，因此需要采用多样化、有针对性的结核病治疗模式。
在巴布亚新几内亚的背景下，评估使用自我管理治疗（SAT）、家庭支持治疗和通过治疗支持者（TS）进行的社区直接观察治疗（DOT）的治疗效果。
对2019 - 2020年两个地点360名患者的常规收集数据进行回顾性描述分析。所有患者根据风险因素（依从性或违约情况）被分配一种治疗模式，并接受患者教育与咨询（PEC）、家庭咨询和交通费用。对每种模式的治疗结局进行评估。
药物敏感结核病（DS - TB）的总体治疗成功率良好：SAT为91.1%，家庭支持治疗为81.4%，DOT患者为77%。SAT与良好结局密切相关（OR 5.7，95% CI 1.7 - 19.3），PEC课程也是如此（OR 4.3，95% CI 2.5 - 7.2）。
在确定治疗模式时考虑风险因素，三组均取得了良好的治疗效果。针对个人需求和风险因素量身定制的多种治疗管理模式，对于难以到达、资源有限的地区来说，是一种可行、有效且以患者为中心的护理模式。
