Department of Tropical Medicine and Infectious Diseases, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Department of Medicine, Daughters of Charity, Saint Vincent de Paul, Carmelo Hospital of Chókwè, Chókwè District, Gaza Province, Mozambique.
BMC Pulm Med. 2024 Oct 10;24(1):502. doi: 10.1186/s12890-024-03329-7.
Despite receiving adequate treatment, many tuberculosis (TB) survivors are left with post-tuberculosis complications, possibly due to lung tissue damage incurred during the active period of the disease. Current TB programs worldwide deliver quality care throughout the course of active TB treatment, yet often fail to provide organized follow-up once treatment ends. Post-tuberculosis lung disease (PTLD) is a prominent, yet underrecognized cause of chronic lung disease, managed similarly to chronic respiratory diseases with pharmacotherapy and/or personalized pulmonary rehabilitation interventions. Basic pulmonary rehabilitation packages for people finishing TB treatment are still lacking in low- and middle-income countries (LMICs). We offer a study protocol to evaluate the implementation of spirometry and symptom screening for PTLD among people who have completed TB treatment in a rural district in Mozambique.
The overall objective of this study is to evaluate the introduction of a new screening program that utilizes symptom screening and spirometry for diagnosing PTLD among adolescents and adults that have completed TB treatment. This research protocol consists of three complementary components: 1) assessing the prevalence of PTLD among patients enrolled in the National TB Control Program (NTCP) at Carmelo Hospital (CHC) in Chókwè District, Mozambique; 2) evaluating anticipated implementation outcomes through the identification of the site-, provider-, and individual-level determinants that either facilitate or hinder the successful adoption, implementation, and maintenance of the spirometry screening program, and 3) evaluating the real-time implementation outcomes/processes in order to provide practical evidence-based key indicators of successful implementation of the spirometry screening program.
Providing well-organized, evidence-based care for individuals with a history of TB who are experiencing symptoms of PTLD can relieve chronic respiratory issues, enhance quality of life, and potentially lower the risk of further pulmonary infections, including recurrent TB. However, there is a significant gap in the literature regarding the implementation of best practices of HIV and TB health services delivery. Addressing this gap could assist Mozambique in improving diagnosis, treatment, and continuity of care for people formerly living with TB. The insights from this study will help decision-makers improve spirometry screening coverage, enhance intervention effectiveness, and translate our findings to evidence-based programming.
ISRCTN92021748 retrospectively registered.
尽管接受了充分的治疗，但许多肺结核（TB）幸存者仍留下了肺结核后并发症，这可能是由于疾病活动期肺组织受损所致。目前全球的结核病规划在结核病治疗期间提供了优质护理，但在治疗结束后往往未能提供有组织的后续服务。肺结核后肺部疾病（PTLD）是慢性肺部疾病的一个突出但认识不足的原因，其管理类似于慢性呼吸道疾病，采用药物治疗和/或个性化肺康复干预。在中低收入国家（LMICs），仍缺乏针对完成结核病治疗的人群的基本肺康复方案。我们提供了一项研究方案，以评估在莫桑比克一个农村地区完成结核病治疗的人群中实施针对 PTLD 的肺活量测定和症状筛查的情况。
本研究的总体目标是评估一项新的筛查计划的实施情况，该计划利用症状筛查和肺活量测定来诊断已完成结核病治疗的青少年和成年人中的 PTLD。该研究方案由三个互补部分组成：1）评估莫桑比克 Chókwè 区 Carmelo 医院国家结核病控制规划（NTCP）登记的患者中 PTLD 的患病率；2）通过确定有利于或阻碍肺活量测定筛查计划成功采用、实施和维持的地点、提供者和个体层面的决定因素，评估预期的实施结果；3）评估实时实施结果/流程，以提供成功实施肺活量测定筛查计划的实用循证关键指标。
为有肺结核病史且出现 PTLD 症状的个体提供组织良好、基于证据的护理，可以缓解慢性呼吸道问题，提高生活质量，并可能降低进一步肺部感染（包括复发性肺结核）的风险。然而，关于艾滋病毒和结核病卫生服务提供的最佳实践的实施情况，文献中存在重大空白。解决这一差距可以帮助莫桑比克改善对曾经患有结核病的人的诊断、治疗和护理连续性。该研究的结果将帮助决策者提高肺活量测定筛查覆盖率，增强干预效果，并将我们的发现转化为基于证据的规划。
ISRCTN92021748 号方案回顾性注册。
