School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Edinburgh, UK.
BMC Infect Dis. 2023 Oct 25;23(1):727. doi: 10.1186/s12879-023-08561-w.
This study assesses the diagnostic delay, treatment duration and treatment outcomes of tuberculosis (TB) patients since the implementation of the integrated model of TB control in a county in eastern China. It further identifies factors associated with diagnostic delay and treatment duration in the integrated model.
We collected data through the Chinese Tuberculosis Information Management System (TBIMS) for Cangnan County in Zhejiang Province. Chi-square and Mann-Whitney tests were adopted to identify factors associated with duration of treatment and treatment delay for TB patients within the integrated model. Multiple regression analysis was subsequently performed to confirm the identified factors.
In the integrated model from 2012 to 2018, the median health system delay was maintained at 1 day, and the median patient delay decreased from 14 to 9 days and the median total delay decreased from 15 to 11 days. In addition, the proportion of patients who experienced patient delay > 14 days and total delay > 28 days decreased from 49% to 35% and from 32% to 29% respectively. However, the proportion of patients who had health system delay > 14 days increased from 0.2% to 13% from 2012 to 2018. The median treatment duration increased from 199 to 366 days and the number of TB patients lost to follow-up showed an overall upward trend from 2012 to 2018. The multivariable regression analysis indicated that migrant TB patients and TB patients initially diagnosed in hospitals at the prefectural level and above tended to experience total delay > 28 days (p < 0.001). Linear regression analysis confirmed that new TB patients>60 years tended to have longer treatment duration (p < 0.05).
While our study may suggest the potential of the integrated model in early detection and diagnosis of TB, it also suggests the importance of strengthening supervision and management of designated hospitals to optimize the treatment duration and improve retention of patients in TB care. Enhancing health education for TB patients, especially amongst migrant patients, and training in TB identification and referral for non-TB doctors are also key for early TB detection and diagnosis in the integrated model.
本研究评估了中国东部某县实施结核病综合防控模式后结核病（TB）患者的诊断延误、治疗持续时间和治疗结局，并进一步确定了该综合模式下与诊断延误和治疗持续时间相关的因素。
我们通过中国结核病信息管理系统（TBIMS）收集了浙江省苍南县的数据。采用卡方检验和曼-惠特尼 U 检验，确定了综合模式下 TB 患者的治疗持续时间和治疗延误相关因素。随后进行多元回归分析以确认所确定的因素。
在 2012 年至 2018 年的综合模式中，卫生系统延迟的中位数保持在 1 天，患者延迟的中位数从 14 天降至 9 天，总延迟的中位数从 15 天降至 11 天。此外，患者延迟>14 天和总延迟>28 天的患者比例从 49%降至 35%和从 32%降至 29%。然而，从 2012 年到 2018 年，卫生系统延迟>14 天的患者比例从 0.2%增加到 13%。治疗持续时间的中位数从 199 天增加到 366 天，从 2012 年到 2018 年，TB 患者失访人数呈总体上升趋势。多变量回归分析表明，流动人口和最初在县级及以上医院诊断的 TB 患者更易出现总延迟>28 天（p<0.001）。线性回归分析证实，年龄>60 岁的新发 TB 患者的治疗持续时间更长（p<0.05）。
虽然我们的研究可能表明综合模式在结核病早期发现和诊断方面具有潜力，但也表明加强对指定医院的监督和管理以优化治疗持续时间和提高结核病患者的保留率的重要性。加强对结核病患者，特别是流动人口的健康教育，以及对非结核病医生进行结核病识别和转诊的培训，对于综合模式下的早期结核病发现和诊断也至关重要。
