Impact of community tracer teams on treatment outcomes among tuberculosis patients in South Africa.
Impact of community tracer teams on treatment outcomes among tuberculosis patients in South Africa.
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DOI：
10.1186/1471-2458-12-621
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发表时间：
2012-08-07
影响因子：
4.5
通讯作者：
Mametja LD
中科院分区：
文献类型：
--
作者：
Bronner LE;Podewils LJ;Peters A;Somnath P;Nshuti L;van der Walt M;Mametja LD
南非的结核病指标目前仍远低于全球目标。2008年，国家结核病规划在所有9个省实施了一项社区动员规划，以追踪错过治疗或诊所就诊的结核病患者。结核病规划管理人员和与卫生机构联系的小组选择了实施地点，以确定患者并开展追踪活动。本分析的目的是评估结核病示踪剂项目对结核病患者治疗结果的影响。研究人群包括2007- 2009年第一季度在南非电子结核病登记处登记的所有涂阳结核病患者。采用分区作为分析单位，每个分区指定为示踪剂（标准结核病规划加上示踪剂项目）或非示踪剂（仅标准结核病规划）。使用混合线性回归模型来计算治疗结果的季度变化百分比，并比较2007年第1季度至2009年第1季度在示踪剂和非示踪剂分区之间的治疗结果变化。对于所有省份的总和，示踪剂街道的默认治疗结果的季度变化百分比显著下降（- 0.031%,p < 0.001），而示踪剂街道的成功治疗结果的季度变化百分比显著增加（0.003%,p = 0.03）。在这段时间内，所有省份的患者违约比例都显著下降，与使用示踪剂和不使用示踪剂的分区相比（p = 0.02）。分层模型的检验结果显示，各省的结果并不一致；在9个省份中，有5个省份的示踪剂和非示踪剂街道随着时间的推移观察到显著差异。社区动员小组追踪错过门诊预约或治疗剂量的结核病患者，可能是降低失诊率和改善治疗结果的有效策略。需要更多的信息来确定最佳做法并阐明各省之间的差异；这些发现将有助于指导国家结核控制规划优化采用结核病控制追踪活动。
Tuberculosis (TB) indicators in South Africa currently remain well below global targets. In 2008, the National Tuberculosis Program (NTP) implemented a community mobilization program in all nine provinces to trace TB patients that had missed a treatment or clinic visit. Implementation sites were selected by TB program managers and teams liaised with health facilities to identify patients for tracing activities. The objective of this analysis was to assess the impact of the TB Tracer Project on treatment outcomes among TB patients. The study population included all smear positive TB patients registered in the Electronic TB Registry from Quarter 1 2007-Quarter 1 2009 in South Africa. Subdistricts were used as the unit of analysis, with each designated as either tracer (standard TB program plus tracer project) or non-tracer (standard TB program only). Mixed linear regression models were utilized to calculate the percent quarterly change in treatment outcomes and to compare changes in treatment outcomes from Quarter 1 2007 to Quarter 1 2009 between tracer and non-tracer subdistricts. For all provinces combined, the percent quarterly change decreased significantly for default treatment outcomes among tracer subdistricts (−0.031%; p < 0.001) and increased significantly for successful treatment outcomes among tracer subdistricts (0.003%; p = 0.03). A significant decrease in the proportion of patient default was observed for all provinces combined over the time period comparing tracer and non-tracer subdistricts (p = 0.02). Examination in stratified models revealed the results were not consistent across all provinces; significant differences were observed between tracer and non-tracer subdistricts over time in five of nine provinces for treatment default. Community mobilization of teams to trace TB patients that missed a clinic appointment or treatment dose may be an effective strategy to mitigate default rates and improve treatment outcomes. Additional information is necessary to identify best practices and elucidate discrepancies across provinces; these findings will help guide the NTP in optimizing the adoption of tracing activities for TB control.
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影响因子：
105.7
作者：
Volmink, J;Garner, P
通讯作者：
Garner, P
影响因子：
5.4
作者：
Demissie, M;Getahun, H;Lindtjorn, B
通讯作者：
Lindtjorn, B
DOI：
10.2471/blt.05.022087
发表时间：
2006-07-10
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Kolappan, C;Subramani, R;Narayanan, PR
通讯作者：
Narayanan, PR
影响因子：
11.8
作者：
Franke, Molly F.;Appleton, Sasha C.;Mitnick, Carole D.
通讯作者：
Mitnick, Carole D.
影响因子：
168.9
作者：
Zwarenstein, M;Schoeman, JH;Tatley, M
通讯作者：
Tatley, M