Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers.
Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers.
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DOI：
10.1093/ofid/ofv030
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发表时间：
2015-01
影响因子：
4.2
通讯作者：
Coutinho A
中科院分区：
文献类型：
--
作者：
Manabe YC;Zawedde-Muyanja S;Burnett SM;Mugabe F;Naikoba S;Coutinho A
背景。 结核病 (TB) 控制是一项公共卫生优先事项，每年有 300 万例结核病未被公共卫生系统识别。我们评估了改进的结核病诊断和现场培训对农村医疗机构结核病病例检测和治疗结果的影响。方法。 10 个医疗机构引入了荧光显微镜、Xpert MTB/RIF 和现场培训。使用准实验方法，将这 10 个干预医疗机构与 2 个对照机构及其上一年的表现进行了比较。结果。 2012年1月至10月，10个干预机构和2个控制机构分别接待了186 357名和32 886名门诊患者。干预设施中进行痰液检查的疑似结核病例比例高出 52.04%（比值比 [OR] = 12.65；95% 置信区间 [CI]，5.60–28.55）。调整年龄组和性别后，干预中开始治疗的涂阳患者比例比对照设施高 37.76%（调整后 OR [AOR]，7.59；95% CI，2.19-26.33）。调整上述因素以及人类免疫缺陷病毒和结核病再治疗状况后，完成治疗的结核病病例比例提高了 29.16%（AOR，4.89；95% CI，2.24-10.67），失访的结核病病例比例降低了 66.98%（AOR，0.04；95% CI， 0.01–0.09）。与基线表现相比，干预设施进行痰液检查的疑似结核病病例比例明显较高（64.70% vs 3.44%；OR，23.95；95% CI，12.96–44.25），并且这些设施在项目期间开始治疗的涂阳结核病病例增加了 56.25%（AOR，15.36；95% CI， 6.57–35.91）。结论。 通过对非医师医疗保健人员进行捆绑诊断和现场培训干预来优化现有医疗保健人员队伍，将迅速改善结核病病例的发现和结果，以实现全球目标。
Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the public health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods. Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare facilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results. From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04% higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95% confidence interval [CI], 5.60–28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76% higher in the intervention than in the control facilities (adjusted OR [AOR], 7.59; 95% CI, 2.19–26.33). After adjusting for the factors above, as well as human immunodeficiency virus and TB retreatment status, the proportion of TB cases who completed treatment was 29.16% higher (AOR, 4.89; 95% CI, 2.24–10.67) and the proportion of TB cases who were lost to follow-up was 66.98% lower (AOR, 0.04; 95% CI, 0.01–0.09). When compared with baseline performance, the intervention facilities had a significantly higher proportion of presumptive TB cases with a sputum examination (64.70% vs 3.44%; OR, 23.95; 95% CI, 12.96–44.25), and these facilities started 56.25% more smear-positive TB cases on treatment during the project period (AOR, 15.36; 95% CI, 6.57–35.91). Conclusions. Optimizing the existing healthcare workforce through a bundled diagnostics and on-site training intervention for nonphysician healthcare workers will rapidly improve TB case detection and outcomes towards global targets.
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影响因子：
3
作者：
Namagembe, Allen;Ssekabira, Umaru;Yeka, Adoke
通讯作者：
Yeka, Adoke
DOI：
10.4269/ajtmh.2008.79.826
发表时间：
2008-12-01
影响因子：
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