Gabdullina Malika, Maes Edmond F, Horth Roberta Z, Dzhazybekova Panagul, Amanova Gulzhan N, Zikriyarova Sanam, Nabirova Dilyara A
Central Asia Field Epidemiology Training Program, Almaty, Kazakhstan.
Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
Front Public Health. 2023 Sep 21;11:1247661. doi: 10.3389/fpubh.2023.1247661. eCollection 2023.
The COVID-19 pandemic negatively influenced the availability of tuberculosis (TB) services, such as detection, diagnosis and treatment, around the world, including Kazakhstan. We set out to estimate the COVID-19 pandemic influence on TB treatment outcomes by comparing outcomes among people starting treatment before the pandemic (2018-2019) and during the pandemic (2020-2021) and to determine risk factors associated with unfavorable outcomes.
We conducted a retrospective cohort study among all people newly diagnosed with drug-sensitive pulmonary or extrapulmonary TB at least 18 years old who initiated treatment from 2018 to 2021 in Almaty. We abstracted data from the national electronic TB register. Unfavorable treatment outcomes were ineffective treatment, death, loss to follow-up, results not evaluated, and transferred. We used multivariable Poisson regression to calculate adjusted relative risk (aRR) and 95% confidence intervals (95%CI).
Among 1548 people newly diagnosed with TB during the study period, average age was 43 years (range 18-93) and 52% were male. The number of people initiating treatment was higher before than the pandemic (935 vs. 613, respectively). There was significantly different proportions before compared to during the pandemic for people diagnosed through routine screening (39% vs. 31%, < 0.001), 60 years and older (16% vs. 22%, = 0.005), and with diabetes (5% vs. 8%, = 0.017). There was no difference in the proportion of HIV (8% in both periods). Unfavorable outcomes increased from 11 to 20% during the pandemic (aRR = 1.83; 95% CI: 1.44-2.31). Case fatality rose from 6 to 9% ( = 0.038). Risk factors for unfavorable TB treatment outcomes among all participants were being male (aRR = 1.44, 95%CI = 1.12-1.85), having HIV (aRR = 2.72, 95%CI = 1.99-3.72), having alcohol use disorder (aRR = 2.58, 95%CI = 1.83-3.62) and experiencing homelessness (aRR = 2.94, 95%CI = 1.80-4.80). Protective factors were being 18-39 years old (aRR = 0.33, 95%CI = 0.24-0.44) and 40-59 years old (aRR = 0.56, 95%CI = 0.41-0.75) compared to 60 years old and up.
COVID-19 pandemic was associated with unfavorable treatment outcomes for people newly diagnosed with drug-sensitive TB in Almaty, Kazakhstan. People with fewer comorbidities were at increased risk. Results point to the need to maintain continuity of care for persons on TB treatment, especially those at higher risk for poor outcomes during periods of healthcare service disruption.
新冠疫情对包括哈萨克斯坦在内的全球结核病（TB）服务的可及性产生了负面影响，如检测、诊断和治疗。我们通过比较在疫情之前（2018 - 2019年）和疫情期间（2020 - 2021年）开始治疗的人群的治疗结果，来评估新冠疫情对结核病治疗结果的影响，并确定与不良结果相关的风险因素。
我们对2018年至2021年在阿拉木图开始治疗的所有新诊断为药敏性肺结核或肺外结核且年龄至少18岁的患者进行了一项回顾性队列研究。我们从国家电子结核病登记册中提取数据。不良治疗结果包括治疗无效、死亡、失访、结果未评估和转诊。我们使用多变量泊松回归来计算调整后的相对风险（aRR）和95%置信区间（95%CI）。
在研究期间新诊断为结核病的1548人中，平均年龄为43岁（范围18 - 93岁），52%为男性。开始治疗的人数在疫情之前高于疫情期间（分别为935人和613人）。通过常规筛查诊断的患者在疫情之前和期间的比例有显著差异（39%对31%，<0.001），60岁及以上患者的比例也有差异（16%对22%，=0.005），患有糖尿病的患者比例也有差异（5%对8%，=0.017）。艾滋病毒感染率在两个时期没有差异（均为8%）。疫情期间不良结果从11%增加到20%（aRR = 1.83；95%CI：1.44 - 2.31）。病死率从6%上升到9%（=0.038）。所有参与者中结核病治疗不良结果的风险因素包括男性（aRR = 1.44，95%CI = 1.12 - 1.85）、感染艾滋病毒（aRR = 2.72，95%CI = 1.99 - 3.72）、患有酒精使用障碍（aRR = 2.58，95%CI = 1.83 - 3.62）和无家可归（aRR = 2.94，95%CI = 1.80 - 4.80）。与60岁及以上相比，18 - 39岁（aRR = 0.33，95%CI = 0.24 - 0.44）和40 - 59岁（aRR = 0.56，95%CI = 0.41 - 0.75）为保护因素。
在哈萨克斯坦阿拉木图，新冠疫情与新诊断为药敏性结核病患者的不良治疗结果相关。合并症较少的人群风险增加。结果表明需要维持结核病治疗患者的连续护理，特别是在医疗服务中断期间预后较差风险较高的患者。
