Jochem K, Fryatt R J, Harper I, White A, Luitel H, Dahal R
International Division, Nuffield Institute for Health, Leeds, UK.
Int J Tuberc Lung Dis. 1997 Dec;1(6):502-8.
A tuberculosis programme in hill and mountain districts of Nepal supported by an international non-governmental organisation (NGO).
To evaluate under programme conditions the effectiveness of unsupervised monthly-monitored treatment using an oral short-course regimen.
In this prospective cohort study, outcomes for new cases of smear-positive tuberculosis starting treatment over a two-year period in four districts in which a 6-month rifampicin-containing regimen was introduced as first-line treatment (subjects) were compared to outcomes for similarly defined cases in four districts where a 12-month regimen with daily streptomycin injections in the intensive phase continued to be used (controls).
Of 359 subjects started on the 6-month regimen, 85.2% completed an initial course of treatment compared to 62.8% of 304 controls started on the 12-month regimen (P < 0.001); 78.8% of subjects and 51.0% of controls were confirmed smear-negative at the end of treatment (P < 0.001). The case-fatality rate during treatment was 5.0% among subjects and 11.2% among controls (P = 0.003). Among those whose status was known at two years, 76.9% of subjects were smear-negative without retreatment, compared to 60.9% of controls (P < 0.001).
In an NGO-supported tuberculosis control programme in remote districts of Nepal, patient-responsible short-course therapy supported by rapid tracing of defaulters achieved acceptable outcomes. Where access and health care infrastructure are poor, district-level tuberculosis teams responsible for treatment planning, drug delivery and programme monitoring can be an appropriate service model.
由一个国际非政府组织支持的尼泊尔山区结核病防治项目。
在项目条件下评估使用口服短程疗法进行无监督每月监测治疗的效果。
在这项前瞻性队列研究中，将四个引入含利福平6个月疗程作为一线治疗的地区（研究对象）中开始治疗的涂片阳性结核病新病例的结果，与四个继续使用强化期每日注射链霉素的12个月疗程的地区中类似定义病例的结果（对照）进行比较。
开始6个月疗程的359名研究对象中，85.2%完成了初始疗程，而开始12个月疗程的304名对照中这一比例为62.8%（P<0.001）；治疗结束时，78.8%的研究对象和51.0%的对照痰涂片转阴（P<0.001）。治疗期间的病死率在研究对象中为5.0%，在对照中为11.2%（P=0.003）。在两年时已知状态的人群中，76.9%的研究对象痰涂片转阴且无需再次治疗，而对照中这一比例为60.9%（P<0.001）。
在尼泊尔偏远地区由非政府组织支持的结核病控制项目中，通过快速追踪违约者支持的患者自主短程治疗取得了可接受的结果。在医疗可及性和卫生保健基础设施较差的地区，负责治疗规划、药物发放和项目监测的地区级结核病防治团队可能是一种合适的服务模式。
