L Bumbu, S Vaccher, A Holmes, K Sodeng, S M Graham, Y D Lin
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引用次数: 0
Abstract
Setting: Papua New Guinea (PNG) is a high-burden country for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB). There are limited data on MDR/RR-TB notifications and treatment from the most populous province.
Objective: Describe MDR/RR-TB detection and treatment outcomes in Morobe Province, the impact of the COVID-19 pandemic and factors associated with unfavourable treatment outcomes.
Design: Retrospective cohort study of MDR/RR-TB notifications between 2012 and 2021 using routine programme registration data. Favourable outcomes were compared to unfavourable outcomes using multivariable regression.
Results: Between 2012 and 2021, 160 cases of MDR/RR-TB were bacteriologically confirmed. Few diagnoses were made among children (2.5%), extrapulmonary cases (0.6%) or rural residents (38%). Case notifications rose sharply from 2016 after the introduction of GeneXpert to 5.6 cases per 100,000 population in 2020 before a reduction in 2021 coinciding with COVID-19 disruptions. Loss to follow-up (27.5%) and death (8.1%) were common. Unfavourable treatment outcomes were more common among male participants (aOR 3.00, 95% CI 1.38-6.45) and those treated with longer injectable-containing regimens (aOR 3.39, 95% CI 1.30-8.80).
Conclusion: MDR/RR-TB detection has increased overall, but enhanced and decentralised diagnostic capacity is needed, including in important sub-populations. Persisting low treatment success rates must be urgently addressed to minimise the further emergence of drug-resistant TB in Morobe Province.
环境：巴布亚新几内亚是耐多药或耐利福平结核病（MDR/RR-TB）的高负担国家。人口最多的省份关于耐多药/耐药结核病的通报和治疗的数据有限。目的：描述Morobe省MDR/RR-TB的检测和治疗结果、COVID-19大流行的影响以及与不利治疗结果相关的因素。设计：采用常规规划登记数据，对2012年至2021年间MDR/RR-TB通报情况进行回顾性队列研究。使用多变量回归对有利结果和不利结果进行比较。结果：2012年至2021年，160例MDR/RR-TB经细菌学证实。在儿童（2.5%）、肺外病例（0.6%）和农村居民（38%）中很少有诊断。病例通报从引入GeneXpert后的2016年大幅上升至2020年的每10万人5.6例，然后在2021年因COVID-19中断而减少。随访失败（27.5%）和死亡（8.1%）较为常见。不良治疗结果在男性参与者（aOR 3.00, 95% CI 1.38-6.45）和使用较长含注射方案治疗的患者（aOR 3.39, 95% CI 1.30-8.80）中更为常见。结论：MDR/RR-TB检测总体上有所增加，但需要加强和分散诊断能力，包括在重要的亚人群中。必须紧急解决治疗成功率持续低下的问题，以尽量减少莫罗贝省耐药结核病的进一步出现。
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.
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