Charles F, Lin Y D, Greig J, Gurra S, Morikawa R, Graham S M, Maha A
The Burnet Institute, Port Moresby, Papua New Guinea (PNG).
The Burnet Institute, Melbourne, VIC, Australia.
Public Health Action. 2024 Sep 1;14(3):85-90. doi: 10.5588/pha.24.0004. eCollection 2024 Sep.
Multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) is now endemic in the National Capital District (NCD), Papua New Guinea. Loss to follow-up (LTFU) is a challenge.
To evaluate and identify risk factors for LTFU, including pre-treatment LTFU, in adults with MDR/RR-TB at Port Moresby General Hospital (PMGH).
A retrospective analysis of treatment initiation in adults diagnosed with MDR/RR-TB (2018-2022) and outcomes for a cohort treated for MDR/RR-TB (2014-2019). We assessed the factors associated with LTFU using multivariate logistic regression.
Of 95 patients diagnosed with MDR/RR-TB at PMGH from 2018 to 2022, 21 (22%) were lost to follow-up before treatment. Of the 658 adults who initiated treatment for MDR/RR-TB at PMGH from 2014 to 2019, 161 (24%) were lost to follow-up during treatment. A higher proportion of patients on injectable-containing long regimens (110/404, 27%) were lost to follow-up than those on the all-oral regimen containing bedaquiline (13/66, 12%). Treatment loss to follow-up was associated with age (35-54 years age group: aOR 0.49, 95% CI 0.32-0.77; 55-75 years age group: aOR 0.42, 95% CI 0.19-0.90; compared to the 15-34 years age group), residence outside of NCD (aOR 1.79, 95% CI 1.04-3.06), and year of treatment initiation.
Pre-treatment LTFU requires programmatic focus. Shorter oral regimens and decentralised services may address the reasons for higher LTFU in younger people and people living outside NCD.
耐多药/利福平耐药结核病（MDR/RR-TB）目前在巴布亚新几内亚首都地区（NCD）呈地方性流行。失访是一项挑战。
评估并确定莫尔斯比港总医院（PMGH）成年MDR/RR-TB患者失访的风险因素，包括治疗前失访。
对2018 - 2022年诊断为MDR/RR-TB的成年患者的治疗起始情况以及2014 - 2019年接受MDR/RR-TB治疗队列的结局进行回顾性分析。我们使用多因素逻辑回归评估与失访相关的因素。
2018年至2022年在PMGH诊断为MDR/RR-TB的95例患者中，21例（占22%）在治疗前失访。2014年至2019年在PMGH开始接受MDR/RR-TB治疗的658例成年患者中，161例（占24%）在治疗期间失访。接受含注射剂的长疗程治疗的患者失访比例（110/404，占27%）高于接受含贝达喹啉的全口服方案治疗的患者（13/66，占12%）。治疗失访与年龄（35 - 岁年龄组：调整后比值比0.49，95%置信区间0.32 - 0.77；55 - 75岁年龄组：调整后比值比0.42，95%置信区间0.19 - 0.9与15 - 34岁年龄组相比）、居住在NCD以外地区（调整后比值比1.79，95%置信区间1.04 - 3.06）以及治疗起始年份有关。
治疗前失访需要项目重点关注。较短的口服方案和分散服务可能解决年轻人和居住在NCD以外地区的人失访率较高的原因。
