Risk factors associated with loss to follow-up from tuberculosis treatment in Tajikistan: a case-control study
Risk factors associated with loss to follow-up from tuberculosis treatment in Tajikistan: a case-control study
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DOI：
10.1186/s12879-017-2655-7
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发表时间：
2017-08-04
影响因子：
3.7
通讯作者：
Verver, Suzanne
中科院分区：
文献类型：
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作者：
Wohlleben, Jessica;Makhmudova, Mavluda;Verver, Suzanne
背景：关于中亚结核病治疗失访原因的研究很少。这项研究评估了 LTFU 的危险因素，并将其发生率与塔吉克斯坦成功治疗 (ST) 的患者进行了比较。方法：这项研究在 19 个地区的所有结核病设施中进行，至少有 5 名结核病患者因治疗而失访 (LTFU)。通过匹配的病例对照设计，我们将 2011 年和 2012 年在选定地区登记的所有 LTFU 患者纳入病例，并将来自同一地区的 ST 患者作为对照。数据是从患者记录和登记册中复制的。运行条件逻辑回归来分析收集的变量和作为因变量的 LTFU 之间的关联。结果：将 300 例病例与 592 例对照进行比较。一半的病例已经迁移或转移。在多变量分析中，与 LTFU 增加相关的危险因素包括迁移到另一个国家（OR 10.6，95% CI 6.12-18.4）、在国内移动（OR 11.0，95% CI 3.50-34.9）、出现治疗副作用（OR 3. 67，95% CI 1.68-8.00）以及之前接受过结核病治疗（OR 2.03， 95% CI 1.05-3.93）。医务人员还提到患者拒绝、耻辱和家庭问题是危险因素。结论：塔吉克斯坦结核病患者的LTFU很大程度上是由于移徙造成的，较小程度上与副作用和既往治疗有关。有必要加强塔吉克斯坦境内和与邻国卫生机构之间的转诊，并为有副作用和/或既往结核病的患者提供支持，以防止因治疗而无法进行随访。
Background: There are very few studies on reasons for loss to follow-up from TB treatment in Central Asia. This study assessed risk factors for LTFU and compared their occurrence with successfully treated (ST) patients in Tajikistan.Methods: This study took place in all TB facilities in the 19 districts with at least 5 TB patients registered as loss to follow-up (LTFU) from treatment. With a matched case control design we included all LTFU patients registered in the selected districts in 2011 and 2012 as cases, with ST patients from the same districts being controls. Data were copied from patient records and registers. Conditional logistic regressions were run to analyse associations between collected variables and LTFU as dependent variable.Results: Three hundred cases were compared to 592 controls. Half of the cases had migrated or moved. In multivariate analysis, risk factors associated with increased LTFU were migration to another country (OR 10.6, 95% CI 6.12-18.4), moving within country (OR 11.0, 95% CI 3.50-34.9), having side effects of treatment (OR 3. 67, 95% CI 1.68-8.00) and being previously treated for TB (OR 2.03, 95% CI 1.05-3.93). Medical staff also mentioned patient refusal, stigma and family problems as risk factors.Conclusions: LTFU of TB patients in Tajikistan is largely a result of migration, and to a lesser extent associated with side-effects and previous treatment. There is a need to strengthen referral between health facilities within Tajikistan and with neighbouring countries and support patients with side effects and/or previous TB to prevent loss to follow-up from treatment.