Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa.
Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa.
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DOI：
10.5588/ijtld.14.0369
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发表时间：
2015-02
期刊：
影响因子：
--
通讯作者：
Padayatchi N
中科院分区：
文献类型：
--
作者：
Loveday M;Wallengren K;Brust J;Roberts J;Voce A;Margot B;Ngozo J;Master I;Cassell G;Padayatchi N
南非夸祖鲁-纳塔尔省是一个以农村为主的省份，结核病、耐多药结核病和艾滋病毒感染负担很高。通过比较社区耐多药结核病治疗结果与中心专科医院的传统治疗结果，确定最有效的治疗模式。一项比较社区护理和集中护理的非随机、观察性前瞻性队列研究。社区中心的患者离家更近，更容易获得护理，从治疗开始就可以获得家庭护理。四个社区站点治疗了736名患者，而813名患者在中央医院接受治疗（共计1 549名患者）。总体而言，75%为HIV合并感染（社区：76% vs.住院：73%，p=0.45），86%接受抗逆转录病毒治疗（社区：91% vs.住院：82%，p=0.22）。在多变量分析中，耐多药结核病患者更有可能有一个成功的治疗结果，如果他们在社区为基础的网站（调整OR=1.43，p=0.01）。然而，在四个以社区为基础的站点中，结果存在异质性，站点1表明家庭护理与72%的治疗成功率增加相关，而其他三个站点的成功率在52 - 60%之间。对耐多药结核病患者的社区护理比在中央专科医院的护理更有效。家庭护理进一步提高了治疗成功率。
KwaZulu-Natal, South Africa a predominantly rural province with high burdens of TB, MDR-TB and HIV infection. To determine the most effective model of care by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital. A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home, had easier access to care and home-based care was available from treatment initiation. Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (a total of 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, p=0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, p=0.22). In multivariate analysis MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR=1.43, p=0.01). However, there was heterogeneity in outcomes at the four community-based sites, with Site 1 demonstrating that home-based care was associated with increased treatment success of 72% compared with success of between 52 - 60% at the other three sites. Community-based care for patients with MDR-TB was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.
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DOI：
10.1056/nejmoa0905848
发表时间：
2010-02-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Abdool Karim SS;Naidoo K;Grobler A;Padayatchi N;Baxter C;Gray A;Gengiah T;Nair G;Bamber S;Singh A;Khan M;Pienaar J;El-Sadr W;Friedland G;Abdool Karim Q
通讯作者：
Abdool Karim Q
影响因子：
3.7
作者：
Zager EM;McNerney R
通讯作者：
McNerney R
影响因子：
1.4
作者：
Oyieng'o, D.;Park, P.;Carter, J.
通讯作者：
Carter, J.
DOI：
10.1196/annals.1425.009
发表时间：
2008-01-01
期刊：
REDUCING THE IMPACT OF POVERTY ON HEALTH AND HUMAN DEVELOPMENT: SCIENTIFIC APPROACHES
影响因子：
--
作者：
Keshavjee, S.;Gelmanova, I. Y.;Shin, S. S.
通讯作者：
Shin, S. S.
影响因子：
3.2
作者：
Tkatchenko-Schmidt, Elena;Atun, Rifat;Renton, Adrian
通讯作者：
Renton, Adrian