Loss to follow-up among adults with drug-resistant TB in Papua New Guinea.

IF 1.3 Q4 RESPIRATORY SYSTEM Public Health Action Pub Date : 2024-09-01 DOI:10.5588/pha.24.0004

F Charles, Y D Lin, J Greig, S Gurra, R Morikawa, S M Graham, A Maha

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Abstract

Setting: Multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) is now endemic in the National Capital District (NCD), Papua New Guinea. Loss to follow-up (LTFU) is a challenge.

Objective: To evaluate and identify risk factors for LTFU, including pre-treatment LTFU, in adults with MDR/RR-TB at Port Moresby General Hospital (PMGH).

Design: A retrospective analysis of treatment initiation in adults diagnosed with MDR/RR-TB (2018-2022) and outcomes for a cohort treated for MDR/RR-TB (2014-2019). We assessed the factors associated with LTFU using multivariate logistic regression.

Results: Of 95 patients diagnosed with MDR/RR-TB at PMGH from 2018 to 2022, 21 (22%) were lost to follow-up before treatment. Of the 658 adults who initiated treatment for MDR/RR-TB at PMGH from 2014 to 2019, 161 (24%) were lost to follow-up during treatment. A higher proportion of patients on injectable-containing long regimens (110/404, 27%) were lost to follow-up than those on the all-oral regimen containing bedaquiline (13/66, 12%). Treatment loss to follow-up was associated with age (35-54 years age group: aOR 0.49, 95% CI 0.32-0.77; 55-75 years age group: aOR 0.42, 95% CI 0.19-0.90; compared to the 15-34 years age group), residence outside of NCD (aOR 1.79, 95% CI 1.04-3.06), and year of treatment initiation.

Conclusion: Pre-treatment LTFU requires programmatic focus. Shorter oral regimens and decentralised services may address the reasons for higher LTFU in younger people and people living outside NCD.

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巴布亚新几内亚成人耐药结核病患者失去随访机会。

背景：巴布亚新几内亚国家首都区（NCD）目前流行耐多药/耐利福平结核病（MDR/RR-TB）。失去随访（LTFU）是一项挑战：评估并确定莫尔兹比港总医院（PMGH）MDR/RR-TB成人患者LTFU（包括治疗前LTFU）的风险因素：对确诊为MDR/RR-TB成人患者的治疗启动情况（2018-2022年）和MDR/RR-TB治疗队列的治疗结果（2014-2019年）进行回顾性分析。我们使用多变量逻辑回归评估了与LTFU相关的因素：2018年至2022年在PMGH确诊为MDR/RR-TB的95名患者中，有21人（22%）在治疗前失去随访。2014年至2019年在PMGH接受MDR/RR-TB治疗的658名成人中，有161人（24%）在治疗期间失去了随访。与使用含有贝达喹啉的全口服治疗方案的患者（13/66，12%）相比，使用含有注射剂的长效治疗方案的患者（110/404，27%）失去随访的比例更高。随访治疗损失与年龄（35-54 岁年龄组：aOR 0.49，95% CI 0.32-0.77；55-75 岁年龄组：aOR 0.42，95% CI 0.19-0.90；与 15-34 岁年龄组相比）、NCD 以外的居住地（aOR 1.79，95% CI 1.04-3.06）和开始治疗的年份有关：结论：治疗前LTFU需要重点关注。较短的口服治疗方案和分散的服务可解决年轻人和居住在 NCD 以外地区的人群中治疗时间较长的原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.