Tuberculosis Treatment Outcomes in Brazil: Different Predictors for Each Type of Unsuccessful Outcome.
Tuberculosis Treatment Outcomes in Brazil: Different Predictors for Each Type of Unsuccessful Outcome.
复制标题
巴西的结核病治疗结果：每种不成功结果的不同预测因子。
DOI：
10.1093/cid/ciac541
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
RegionalProspectiveObservational
中科院分区：
文献类型：
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作者：
Ridolfi,Felipe;Peetluk,Lauren;Amorim,Gustavo;Turner,Megan;Figueiredo,Marina;Cordeiro-Santos,Marcelo;Cavalcante,Solange;Kritski,Afrânio;Durovni,Betina;Andrade,Bruno;Sterling,TimothyR;Rolla,Valeria;RegionalProspectiveObservational
研究背景成功的结核病治疗是疾病控制的必要条件。世界卫生组织（WHO）的目标是结核病治疗成功率≥ 90%。我们评估了不同类型的不利结核病治疗结果是否有不同的预测因素。方法使用巴西结核病区域前瞻性观察性研究的数据，我们评估了与不成功结核病结果的每个组成部分相关的生物和行为因素，最近由世界卫生组织更新（死亡、失访[LTFU]和治疗失败）。我们纳入了2015-2019年接受标准治疗的经培养确诊、药物敏感的肺结核参与者。多项logistic回归模型与逆概率加权被用来评估每个不成功的outcome.ResultsOf 915参与者的不同决定因素，727（79%）被成功治疗，118（13%）是LTFU，44（5%）治疗失败，26（3%）死亡。LTFU与当前药物使用（调整后的比值比[aOR] = 5.3; 95%置信区间[CI]，3.0-9.4）、当前烟草使用（aOR = 2.9; 95% CI，1.7-4.9）和HIV感染者（PWH）（aOR = 2.0; 95% CI，1.1-3.5）相关。治疗失败与PWH（aOR = 2.7; 95% CI，1.2-6.2）和糖尿病（aOR = 2.2; 95% CI，1.1-4.4）相关。死亡与贫血（aOR = 5.3; 95% CI，1.4-19.7）、糖尿病（aOR = 3.1; 95% CI，1.4-6.7）和PWH（aOR = 3.9; 95% CI，1.3-11.4）相关。直接观察治疗对治疗失败（aOR = 0.5; 95%CI，0.3 - 0.9）和死亡（aOR = 0.5; 95%CI，0.2 -1.0）具有保护作用。行为因素与LTFU最相关，而临床合并症与治疗失败和死亡相关。由于不成功的结果的决定因素是不同的，可能需要不同的干预策略，以改善结核病的结果。
BackgroundSuccessful tuberculosis (TB) treatment is necessary for disease control. The World Health Organization (WHO) has a target TB treatment success rate of ≥90%. We assessed whether the different types of unfavorable TB treatment outcome had different predictors.MethodsUsing data from Regional Prospective Observational Research for Tuberculosis-Brazil, we evaluated biological and behavioral factors associated with each component of unsuccessful TB outcomes, recently updated by WHO (death, loss to follow-up [LTFU], and treatment failure). We included culture-confirmed, drug-susceptible, pulmonary TB participants receiving standard treatment in 2015–2019. Multinomial logistic regression models with inverse probability weighting were used to evaluate the distinct determinants of each unsuccessful outcome.ResultsOf 915 participants included, 727 (79%) were successfully treated, 118 (13%) were LTFU, 44 (5%) had treatment failure, and 26 (3%) died. LTFU was associated with current drug-use (adjusted odds ratio [aOR] = 5.3; 95% confidence interval [CI], 3.0–9.4), current tobacco use (aOR = 2.9; 95% CI, 1.7–4.9), and being a person with HIV (PWH) (aOR = 2.0; 95% CI, 1.1–3.5). Treatment failure was associated with PWH (aOR = 2.7; 95% CI, 1.2–6.2) and having diabetes (aOR = 2.2; 95% CI, 1.1–4.4). Death was associated with anemia (aOR = 5.3; 95% CI, 1.4–19.7), diabetes (aOR = 3.1; 95% CI, 1.4–6.7), and PWH (aOR = 3.9; 95% CI, 1.3–11.4). Direct observed therapy was protective for treatment failure (aOR = 0.5; 95% CI, .3–.9) and death (aOR = 0.5; 95% CI, .2–1.0).ConclusionsThe treatment success rate was below the WHO target. Behavioral factors were most associated with LTFU, whereas clinical comorbidities were correlated with treatment failure and death. Because determinants of unsuccessful outcomes are distinct, different intervention strategies may be needed to improve TB outcomes.