Pretreatment loss to follow-up of tuberculosis patients in Chennai, India: a cohort study with implications for health systems strengthening
Pretreatment loss to follow-up of tuberculosis patients in Chennai, India: a cohort study with implications for health systems strengthening
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DOI：
10.1186/s12879-018-3039-3
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发表时间：
2018-03-27
影响因子：
3.7
通讯作者：
Mayer, Kenneth H.
中科院分区：
文献类型：
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作者：
Thomas, Beena E.;Subbaraman, Ramnath;Mayer, Kenneth H.
背景：在印度修订的国家结核病控制规划（RNTCP）中，治疗前失访（PTLFU）是结核病控制的一个障碍。PTLFU研究还没有进行在印度的大城市，患者的流动性可能会复杂的联系到care.Methods：我们收集了2015年5月从22 RNTCP指定的显微镜中心（DMC）在钦奈和审计的地址和电话号码的患者登记处的数据评估疑似结核病，以了解如何失踪的联系信息可能有助于PTLFU。从2015年11月到2016年6月，我们审计了这22个DMC中每个DMC的一个月记录，并使用RNTCP记录，电话和家访跟踪新诊断的痰检阳性患者。我们将PTLFU病例定义为：（1）14天内未开始TB治疗的患者，以及（2）开始TB治疗但在正式RNTCP注册之前失访或死亡的患者。我们使用多变量logistic回归来确定与PTLFU.Results相关的因素：在2015年5月DMC登记处的审计中，在3696名评估TB的患者中，1273名（34.4%）的地址和电话号码难以辨认或缺失。在2015年11月至2016年6月追踪的344名涂阳患者中，40名（11.6%）在14天内没有开始结核病治疗，36名（10.5%）开始治疗，但在正式RNTCP注册之前失访或死亡，总体PTLFU率为22.1%（95% CI：17.8%-26.4%）。在所有PTLFU患者中，55例（72.4%）失访，21例（27.6%）在开始治疗前或RNTCP注册前死亡。在回归分析中，年龄>50岁（OR 2.9，95% CI 1.4-6.5），既往TB病史（OR 3.9，95% CI 2.2-7.1），在高患者容量DMC下进行评价（OR 3.2，95% CI 1.7-6.3），且无清晰的患者联系信息（OR 4.5，95% CI 1.3-15.1）与PTLFU显著相关。在印度的一个大城市，我们发现PTLFU率很高，特别是在有结核病史的患者中，他们有更大的耐药性风险。提高护理质量和卫生系统透明度对于改善印度城市新诊断患者与结核病护理的联系至关重要。
Background: Pretreatment loss to follow-up (PTLFU) is a barrier to tuberculosis (TB) control in India's Revised National TB Control Programme (RNTCP). PTLFU studies have not been conducted in India's mega-cities, where patient mobility may complicate linkage to care.Methods: We collected data from patient registries for May 2015 from 22 RNTCP designated microscopy centers (DMCs) in Chennai and audited addresses and phone numbers for patients evaluated for suspected TB to understand how missing contact information may contribute to PTLFU. From November 2015 to June 2016, we audited one month of records from each of these 22 DMCs and tracked newly diagnosed smear-positive patients using RNTCP records, phone calls, and home visits. We defined PTLFU cases as including: (1) patients who did not start TB therapy within 14 days and (2) patients who started TB therapy but were lost to follow-up or died before official RNTCP registration. We used multivariate logistic regression to identify factors associated with PTLFU.Results: In the audit of May 2015 DMC registries, out of 3696 patients evaluated for TB, 1273 (34.4%) had addresses and phone numbers that were illegible or missing. Out of 344 smear-positive patients tracked from November 2015 to June 2016, 40 (11.6%) did not start TB therapy within 14 days and 36 (10.5%) started therapy but were lost to follow-up or died before official RNTCP registration, for an overall PTLFU rate of 22.1% (95% CI: 17.8%-26.4%). Of all PTLFU patients, 55 (72.4%) were lost to follow-up and 21 (27.6%) died before starting treatment or before RNTCP registration. In the regression analysis, age >50 years (OR 2.9, 95% CI 1.4-6.5), history of prior TB (OR 3.9, 95% CI 2.2-7.1), evaluation at a high patient volume DMC (OR 3.2, 95% CI 1.7-6.3), and absence of legible patient contact information (OR 4.5, 95% CI 1.3-15.1) were significantly associated with PTLFU.Conclusions: In an Indian mega-city, we found a high PTLFU rate, especially in patients with a prior TB history, who are at greater risk for having drug-resistance. Enhancing quality of care and health system transparency is critical for improving linkage of newly diagnosed patients to TB care in urban India.