The impact of rural residence and HIV infection on poor tuberculosis treatment outcomes in a large urban hospital: a retrospective cohort analysis
The impact of rural residence and HIV infection on poor tuberculosis treatment outcomes in a large urban hospital: a retrospective cohort analysis
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DOI：
10.1186/s12939-017-0714-8
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发表时间：
2018-01-08
影响因子：
4.8
通讯作者：
Abubakar, Ibrahim
中科院分区：
文献类型：
--
作者：
Adamu, Aishatu Lawal;Aliyu, Muktar H.;Abubakar, Ibrahim
背景：成功的结核病治疗是有效控制结核病的关键。结核病-艾滋病毒混合感染、社会决定因素和受农村居住地影响的获得服务的机会可能会影响治疗结果。我们研究了在尼日利亚卡诺一家大型结核病治疗中心登记的患者中，农村居民和HIV感染对不良治疗结果的单独和联合影响。方法：我们回顾分析了2010年1月至2014年12月在尼日利亚北部一家大型城市结核病诊所登记的结核病患者队列。不良治疗结果被定义为死亡、违约或治疗失败。结果：在1381例患者中，28.4%为农村居民，39.8%为HIV阳性，46.1%为不良治疗结果。大约65%的农村居民和38%的城市居民的治疗结果很差。与城市居民相比，农村居民治疗结果差的风险是城市居民的2.74倍(95%可信区间：2.27-3.29)。与HIV阴性患者相比，HIV阳性患者治疗结果差的风险是HIV阴性患者的1.4倍(95%CI：1.16-1.69)。农村居住地(人口归因分数，PAF)导致治疗结果差的比例为25.6%。HIV感染的PAF为11.9%。农村居民对HIV阴性患者治疗效果差的影响(ARR：4.07；95%CI：3.15~5.25)是HIV阳性患者(ARR：1.99；95%CI：1.49~2.64)的两倍以上。结论：在尼日利亚大型结核病诊所就诊的农村居民治疗效果差的风险增加，这种风险在HIV阴性患者中放大。我们的研究结果表明，农村艾滋病毒服务的覆盖率可能好于结核病服务。这些发现突显了扩大结核病服务覆盖面的重要性，以确保及时诊断和开始治疗，特别是在资源有限的农村居民中。
Background: Successful tuberculosis (TB) treatment is essential to effective TB control. TB-HIV coinfection, social determinants and access to services influenced by rural residence can affect treatment outcome. We examined the separate and joint effects of rural residence and HIV infection on poor treatment outcome among patients enrolled in a large TB treatment centre in Kano, Nigeria.Methods: We retrospectively analysed a cohort of patients with TB enrolled in a large urban TB clinic in northern Nigeria, from January 2010 to December 2014. Poor treatment outcome was defined as death, default or treatment failure. We used Poisson regression to model rates and determine the relative risks (and 95% confidence intervals, CI) of poor treatment outcomes.Results: Among 1381 patients included in the analysis, 28.4% were rural residents; 39.8% were HIV-positive; and 46.1% had a poor treatment outcome. Approximately 65 and 38% of rural and urban residents, respectively, had a poor treatment outcome. Rural residents had 2.74 times (95% CI: 2.27-3.29) the risk of having a poor treatment outcome compared to urban residents. HIV-positive patients had 1.4 times (95% CI: 1.16-1.69) the risk of poor treatment outcome compared to HIV-negative patients. The proportion of poor treatment outcome attributable to rural residence (population attributable fraction, PAF) was 25.6%. The PAF for HIV infection was 11.9%. The effect of rural residence on poor treatment outcome among HIV-negative patients (aRR: 4.07; 95% CI: 3.15-5.25) was more than twice that among HIV-positive patients (aRR: 1.99; 95% CI: 1.49-2.64).Conclusion: Rural residents attending a large Nigerian TB clinic are at increased risk of having poor treatment outcomes, and this risk is amplified among those that are HIV-negative. Our findings indicate that rural coverage of HIV services may be better than TB services. These findings highlight the importance of expanding coverage of TB services to ensure prompt diagnosis and commencement of treatment, especially among rural-dwellers in resource-limited settings.