Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2023 Aug 14;18(8):e0289830. doi: 10.1371/journal.pone.0289830. eCollection 2023.
People with tuberculosis (TB) are often lost to follow-up during treatment transition to another facility. These losses may result in substantial morbidity and mortality but are rarely recorded. We conducted a record review on adults diagnosed with TB at 11 hospitals in Limpopo, South Africa, who were subsequently transferred to a local clinic to initiate or continue treatment. We then performed in-depth record reviews at the primary care clinic to which they were referred and called participants who could not be identified as starting treatment. Between August 2017 and April 2018, we reviewed records of 778 individuals diagnosed with TB in-hospital and later referred to local clinics for treatment. Of the 778, 88 (11%) did not link to care, and an additional 43 (5.5%) died. Compared to people without cough, those with cough had higher odds of linking to care (aOR = 2.01, 95% CI: 1.26-3.25, p = 0.005) and were also linked more quickly [adjusted Time Ratio (aTR) = 0.53, 95% CI:0.36-0.79, p<0.001], as were those diagnosed microbiologically (aOR = 1.86, 95% CI: 1.16-3.06, p = 0.012; aTR = 0.58, 95% CI: 0.34-0.98, p = 0.04). People diagnosed with TB in hospitals often disengage following referral to local clinics. Interventions to identify and re-engage people who do not present to local clinics within days of referral might close an important gap in the TB treatment cascade.
在治疗过渡期间，患有结核病（TB）的人往往会失去随访。这些损失可能导致大量发病率和死亡率，但很少被记录下来。我们对南非林波波省 11 家医院诊断出的结核病成人患者进行了病历回顾，这些患者随后被转至当地诊所开始或继续治疗。然后，我们在他们转至的初级保健诊所进行了深入的病历回顾，并联系了无法确定开始治疗的参与者。2017 年 8 月至 2018 年 4 月期间，我们回顾了在医院诊断出的 778 名结核病患者的记录，随后他们被转至当地诊所接受治疗。在 778 名患者中，有 88 名（11%）没有联系到护理人员，另有 43 名（5.5%）死亡。与无咳嗽者相比，有咳嗽者更有可能联系到护理人员（调整后优势比[aOR] = 2.01，95%置信区间：1.26-3.25，p = 0.005），并且也更快地联系到护理人员[调整后时间比（aTR）= 0.53，95%置信区间：0.36-0.79，p<0.001]，微生物学诊断的患者也是如此[aOR = 1.86，95%置信区间：1.16-3.06，p = 0.012；aTR = 0.58，95%置信区间：0.34-0.98，p = 0.04]。在医院诊断出结核病的患者经常在转至当地诊所后失去联系。发现并重新联系那些在转至当地诊所后几天内未出现的患者的干预措施可能会缩小结核病治疗链中的一个重要差距。
