Community-based treatment of multidrug-resistant tuberculosis: early experience and results from Western Kenya
Community-based treatment of multidrug-resistant tuberculosis: early experience and results from Western Kenya
复制标题
DOI：
10.5588/pha.12.0002
复制
发表时间：
2012-06-21
影响因子：
1.4
通讯作者：
Carter, J.
中科院分区：
文献类型：
--
作者：
Oyieng'o, D.;Park, P.;Carter, J.
背景：根据 2010 年世界卫生组织估计全球有 65 万例耐多药结核病 (MDR-TB) 病例，制定、实施和扩大耐多药结核病治疗计划的必要性是显而易见的。肯尼亚等资源匮乏国家的需求最为迫切，结核病负担较高，而且随着药敏试验的普及，耐多药结核病报告病例预计会增加。目标：描述基于社区的计划的设置、早期临床结果、挑战和可能的解决方案。地点：莫伊教学和转诊医院（莫伊医院）服务区域：肯尼亚西裂谷省和北裂谷省。设计：计划描述和回顾性图表审查。结果：耐多药结核病团队通过基于家庭的 DOT 或基于当地设施的 DOT 建立了一个基于社区的计划。转诊后，该团队进行了家访，确定并聘请了一名交通部工作人员，对家庭和当地医疗保健专业人员进行了耐多药结核病护理培训，并启动了基于社区的耐多药结核病治疗。在最初的 24 个月内，有 14 名患者被转诊，其中 5 名患者在开始治疗前死亡，其中 1 名患者患有广泛耐药结核病。在开始社区 DOT 的 8 名患者中，87% 的患者在 6 个月内进行了培养转化，75% 的患者在中位随访 15.5 个月后治愈且无复发。经历了多重挑战，包括系统延迟、耻辱和资金有限。结论：尽管面临多重挑战，我们的耐多药结核病团队模式建立了一个围绕确诊病例的社区治疗系统，这是可行的，治疗结果是可接受的。
Background: In the light of the 2010 World Health Organization estimation of 650 000 cases of multidrug-resistant tuberculosis (MDR-TB) globally, the need to develop, implement and scale up MDR-TB treatment programs is clear. The need is greatest and urgent in resource-poor countries, such as Kenya, with a high TB burden and an anticipated rise in reported cases of MDR-TB with increasing access to drug susceptibility testing.Objectives: To describe the set-up of a community-based program, early clinical outcomes, challenges and possible solutions.Setting: The Moi Teaching and Referral Hospital (Moi Hospital) catchment areas: Western and North Rift Provinces, Kenya.Design: Program description and retrospective chart review.Results: An MDR-TB team established a community-based program with either home-based DOT or local facility-based DOT. Following referral, the team instituted a home visit, identified and hired a DOT worker, trained family and local health care professionals in MDR-TB care and initiated community-based MDR-TB treatment. In the first 24 months, 14 patients were referred, 5 died prior to initiation of treatment and one had extensively drug-resistant TB. Among eight patients who initiated community-based DOT, 87% underwent culture conversion by 6 months, and 75% were cured with no relapse after a median followup of 15.5 months. Multiple challenges were experienced, including system delays, stigma and limited funding.Conclusion: Despite multiple challenges, our model of an MDR-TB team that establishes a community-based treatment system encircling diagnosed cases of MDR-TB is feasible, with acceptable treatment outcomes.