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Breakthrough TB among people living with HIV on TB preventive therapy. 艾滋病毒感染者结核病预防治疗取得突破性进展。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0016
S Nyangu, M Kagujje, I Mwaba, D Luhanga, R Hambwalula, S Maliko, T Mushili, E Mwamba, Mukaba Mulai, Monde Muyoyeta

Background: Zambia has an estimated TB incidence of 319/100,000 population and a HIV prevalence of 11.1%. In 2020, only 49% of new people living with HIV (PLHIV) received TB preventive therapy (TPT) in Zambia. Misconceptions about the reliability of symptom screening and drug resistance among people who develop TB while on TPT are barriers to TPT scale-up. We determined the incidence and predictors of breakthrough TB during TPT among PLHIV in Zambia.

Method: This was a retrospective analysis of routine TPT programme data among PLHIV collected between October 2016 and October 2019 from select primary health facilities in Zambia.

Results: Of 48,581 PLHIV enrolled on TPT, 130 (0.3%) developed breakthrough TB during TPT. Of the 130, 90 client records were accessed. The median age of the breakthrough TB cases was 35 years; 68% were males. Overall, 96% of the breakthrough TB cases had been on antiretroviral therapy (ART) for ⩽3 months; 24% were symptomatic at the beginning of TPT, 22% were asymptomatic and others had missing data. Of the 130 breakthrough TB cases, 79% developed TB in the first month after TPT initiation. The median time to TB diagnosis was 10 days (IQR 4-16).

Conclusion: Breakthrough TB during TPT is rare among PHLIV on ART, and very rare after the first month of TPT initiation. It should therefore not be a barrier to TPT scale-up.

背景:赞比亚估计结核病发病率为319/10万人,艾滋病毒患病率为11.1%。2020年,赞比亚只有49%的新发艾滋病毒感染者接受了结核病预防治疗。对症状筛查的可靠性和在接受TPT治疗期间出现结核病患者的耐药性的误解是扩大TPT治疗的障碍。我们确定了赞比亚艾滋病毒感染者TPT治疗期间突破性结核病的发病率和预测因素。方法:回顾性分析2016年10月至2019年10月从赞比亚选定的初级卫生机构收集的艾滋病毒感染者常规TPT规划数据。结果:在接受TPT治疗的48,581名PLHIV患者中,130名(0.3%)在TPT治疗期间发展为突破性结核病。在这130条记录中,有90条客户记录被访问。突破结核病例的中位年龄为35岁;68%是男性。总体而言,96%的突破性结核病例已接受抗逆转录病毒治疗(ART)≥3个月;24%的患者在TPT开始时有症状,22%的患者无症状,其他患者数据缺失。在130例突破性结核病例中,79%在开始TPT治疗后的第一个月发生结核。到结核诊断的中位时间为10天(IQR 4-16)。结论:在接受抗逆转录病毒治疗的PHLIV患者中,TPT治疗期间出现突破结核的情况非常罕见,而在TPT治疗开始的第一个月后更是非常罕见。因此,它不应成为扩大TPT的障碍。
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引用次数: 0
Antimicrobial resistance in bacteria isolated from the poultry production system in Nepal. 从尼泊尔家禽生产系统分离的细菌的抗微生物药物耐药性。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0014
P Pal, R Bhatta, R Bhattarai, P Acharya, S Singh, A D Harries

Setting: Twenty poultry farms in five provinces of Nepal were selected for studying bacterial pathogens and their antimicrobial resistance (AMR) patterns.

Objective: To document the proportion of cloacal swabs collected from 3,230 broiler and 3,230 layer chickens from September to December 2021 that grew isolates of Escherichia coli, Enterococcus spp. and Salmonella spp. along with their AMR patterns.

Design: This was a cross-sectional descriptive study.

Results: In broiler birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 36%, 39% and 63% of swabs. In layer birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 31%, 48% and 60% of swabs. For both bird types, there was variation in bacterial prevalence between the regions. For all three bacterial isolates, the lowest antimicrobial resistance was found with amikacin. For the other nine antibiotics tested, >50% of bacterial isolates showed resistance; between 60% and 90% of isolates showed resistance to ciprofloxacin and trimethoprim-sulfamethoxazole. Multidrug resistance ranged from 45% to 46% for Salmonella spp., 37-44% for E. coli and 13-17% for Enterococcus spp.

Conclusion: This study shows that a large proportion of poultry in Nepal are infected with potentially pathogenic bacteria, and these are frequently resistant to commonly used antibiotics. Nepal urgently needs to implement corrective measures.

环境:选择尼泊尔5个省的20个家禽养殖场来研究细菌病原体及其抗微生物药物耐药性(AMR)模式。目的:记录2021年9月至12月采集的3230只肉鸡和3230只蛋鸡的肛肠样本中大肠埃希菌、肠球菌和沙门氏菌分离株的比例及其抗生素耐药性模式。设计:这是一项横断面描述性研究。结果:肉鸡拭子检出肠球菌、沙门氏菌和大肠杆菌的检出率分别为36%、39%和63%。蛋鸡中肠球菌、沙门氏菌和大肠杆菌的检出率分别为31%、48%和60%。对于这两种鸟类,不同地区之间的细菌流行率存在差异。对于所有三种细菌分离株,发现阿米卡星的抗菌素耐药性最低。对于其他9种抗生素,>50%的细菌分离株表现出耐药性;60%至90%的分离株对环丙沙星和甲氧苄啶-磺胺甲恶唑耐药。沙门氏菌耐多药率为45% - 46%,大肠杆菌为37-44%,肠球菌为13-17%。结论:本研究表明,尼泊尔大部分家禽感染了潜在致病菌,这些细菌经常对常用抗生素产生耐药性。尼泊尔迫切需要实施纠正措施。
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引用次数: 0
Facilitators and barriers to TB care during the COVID-19 pandemic. COVID-19大流行期间结核病治疗的促进因素和障碍。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0039
M A Franke, L M Truß, H Wierenga, K Nordmann, A Frühauf, R Ranaivoson, Z Rampanjato, F Ranjaharinony, S Knauss, N Muller, J V Emmrich

Background: Knowledge about factors influencing access and adherence to TB care, and on the impact of the COVID-19 pandemic on TB care in resource-restricted settings is scarce. We conducted this study in Atsimo-Andrefana, a rural region in southern Madagascar where TB prevalence, poverty and food insecurity rates are high. We aimed to determine facilitators and barriers to access to and provision of TB care in rural Madagascar during the COVID-19 pandemic.

Methods: We conducted qualitative focus group discussions (FGDs) and in-depth interviews (IDIs) with patients with TB, community health workers, facility-based health workers, public health officials and non-governmental organisation staff. We analysed interviews using thematic analysis.

Results: We conducted 11 FGDs and 23 IDIs. We identified three main barriers to access and adherence to TB care: 1) stigma, 2) indirect treatment costs, and 3) food insecurity. The facilitator perceived as most influential was high health worker motivation. The effects of the COVID-19 pandemic on TB care varied between stake-holders; some health workers described delays in TB diagnosis and increased workload.

Conclusions: To improve access and adherence to TB care, both indirect treatment costs and stigma need to be reduced; undernourished patients with TB should receive food support.

背景:在资源有限的环境中,关于结核病治疗可及性和坚持性的影响因素以及COVID-19大流行对结核病治疗的影响的知识很少。我们在Atsimo-Andrefana进行了这项研究,这是马达加斯加南部的一个农村地区,结核病患病率、贫困率和粮食不安全率都很高。我们的目的是确定COVID-19大流行期间马达加斯加农村地区获得和提供结核病治疗的促进因素和障碍。方法:我们对结核病患者、社区卫生工作者、设施卫生工作者、公共卫生官员和非政府组织工作人员进行了定性焦点小组讨论(fgd)和深度访谈(IDIs)。我们使用主题分析来分析访谈。结果:共进行fgd 11例,IDIs 23例。我们确定了获得和坚持结核病治疗的三个主要障碍:1)耻辱,2)间接治疗费用,以及3)粮食不安全。被认为最有影响力的促进因素是卫生工作者的积极性很高。COVID-19大流行对结核病治疗的影响因利益攸关方而异;一些卫生工作者描述了结核病诊断的延误和工作量的增加。结论:为了改善结核病治疗的可及性和依从性,需要减少间接治疗费用和污名;营养不良的结核病患者应得到食物支持。
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引用次数: 1
Reasons for missed opportunities to screen and test for TB in healthcare facilities. 错过医疗机构结核病筛查和检测机会的原因。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0042
L de Vos, E Mazinyo, D Bezuidenhout, N Ngcelwane, D S Mandell, S H Schriger, J Daniels, A Medina-Marino

Missed opportunities for TB screening and/or passive testing in clinics continues to contribute to the number of missed cases. To understand reasons for these missed opportunities, we conducted focus group discussions with clinic-based nurses. Nurses described low indices of suspicion, prioritization of seemingly more urgent ailments and clinic operational challenges as barriers to TB screening and testing. To improve TB screening and testing in clinics, standard patients should be used to identify real-time factors that impact nurses' clinical decision-making and engage in real-time feedback and discussion with nurses to help optimize opportunities for TB screening and testing.

错过了在诊所进行结核病筛查和/或被动检测的机会,继续导致错过病例的数量增加。为了了解这些错失机会的原因,我们与诊所护士进行了焦点小组讨论。护士们将低怀疑指数、看似更紧急的疾病的优先顺序以及诊所运营挑战描述为结核病筛查和检测的障碍。为了改善诊所的结核病筛查和检测,应使用标准患者来识别影响护士临床决策的实时因素,并与护士进行实时反馈和讨论,以帮助优化结核病筛查和测试的机会。
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引用次数: 0
Causes of pre-treatment loss to follow-up in patients with TB. 结核病患者治疗前随访损失的原因。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0051
S Daka, Y Matsuoka, M Ota, S Hirao, A Phiri

Setting: Five urban TB diagnostic centres in Lusaka, Zambia.

Objective: To determine the proportion of bacteriologically confirmed pre-treatment lost to follow-up (LTFU) patients with TB found at the study settings in 2020.

Design: This was a retrospective cohort study in which the TB laboratory and treatment registers at the study sites were cross-matched.

Results: A total of 1,085 bacteriologically confirmed patients with TB were found in the laboratory TB registers at the study settings. Of these, 809 (74.6%) were males, whereas 8 (0.7%) were children, 1,005 (92.6%) were diagnosed using Xpert, 78 (7.2%) by microscopy. A total of 91 (8.4%, 95% CI 6.8-10.2) were determined to be pre-treatment LTFU. Those who had very low (14.0%, 95% CI 8.5-21.2) and low (11.8%, 95% CI 8.4-16.0) results on Xpert were respectively 3.1 (95% CI 1.6-6.0) and 2.6 (95% CI 1.4-4.8) times more likely to become pre-treatment LTFU than those who had medium (4.5%, 95% CI 2.5-7.4) results. The proportions of pre-treatment LTFU varied among the study sites from 0.7% to 16.1%.

Conclusion: Health facilities should strive to account for every patient with TB, with particular attention to those who are bacteriologically confirmed.

环境:赞比亚卢萨卡的五个城市结核病诊断中心。目的:确定2020年在研究环境中发现的细菌学证实的治疗前失访(LTFU)结核病患者的比例。设计:这是一项回顾性队列研究,研究地点的结核病实验室和治疗登记是交叉匹配的。结果:在研究设置的实验室结核病登记中共发现1,085名细菌学确诊的结核病患者。其中,809例(74.6%)为男性,8例(0.7%)为儿童,1005例(92.6%)为Xpert诊断,78例(7.2%)为显微镜诊断。共有91例(8.4%,95% CI 6.8-10.2)被确定为治疗前LTFU。Xpert结果非常低(14.0%,95% CI 8.5-21.2)和低(11.8%,95% CI 8.4-16.0)的患者成为治疗前LTFU的可能性分别是中度(4.5%,95% CI 2.5-7.4)患者的3.1倍(95% CI 1.6-6.0)和2.6倍(95% CI 1.4-4.8)。处理前LTFU的比例在研究地点从0.7%到16.1%不等。结论:卫生机构应努力对每一位结核病患者作出解释,特别注意那些经细菌学证实的患者。
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引用次数: 0
The pandemic is not the great equalizer: front-line labor and rationing in COVID-19 critical care. 大流行并不是一个伟大的均衡器:一线劳动力和COVID-19重症监护的配给。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0025
N Navuluri, H S Solomon, C W Hargett, P S Kussin

Background: Framed as "the great-equalizer," the COVID-19 pandemic has intensified pressure to adapt critical care labor and resulted in rationing by healthcare workers across the world.

Objective: To critically investigate how hospital intensive care units are critical sites of care labor and examine how rationing highlights key features of healthcare labor and its inequalities.

Methods: A practice-oriented ethnographic study was conducted in a United States academic ICU by a medical anthropologist and medical intensivists with global health expertise. The analysis drew on 57 in-depth interviews and 25 months of participant observation between 2020 and 2021.

Results: Embodied labor constitutes sites and practices of shortage or rationing along three domains: equipment and technology, labor, and emotions and energy. The resulting workers' practices of adaptation and resilience point to a potentially more robust global health labor politics based on seeing rationing as work.

Conclusion: Studies of pandemic rationing practices and critical care labor can disrupt too-simple comparative narratives of Global North/South divides. Further studies and efforts must address the toll of healthcare labor.

背景:COVID-19大流行被称为“伟大的均衡器”,加大了调整重症监护劳动力的压力,并导致世界各地的卫生保健工作者实行配给。目的:批判性地调查医院重症监护病房如何成为护理劳动的关键场所,并检查配给如何突出医疗劳动的关键特征及其不平等。方法:由一名医学人类学家和具有全球卫生专业知识的医学重症监护医师在美国的一个学术ICU进行了一项以实践为导向的民族志研究。该分析在2020年至2021年期间进行了57次深度访谈和25个月的参与者观察。结果:具身劳动构成了三个领域短缺或配给的场所和实践:设备和技术,劳动力,情感和能量。由此产生的工人适应和恢复能力的实践表明,在将定量配给视为工作的基础上,全球卫生劳工政治可能会更加强大。结论:对流行病配给做法和重症监护劳动的研究可以打破过于简单的全球南北划分的比较叙述。进一步的研究和努力必须解决医疗保健劳动力的损失。
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引用次数: 0
Reasons for poor uptake of TB preventive therapy in South Africa. 南非结核病预防治疗使用率低的原因。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0030
D P Baloyi, M G Anthony, K A Meyerson, S Mazibuko, D Wademan, L Viljoen, H Myburgh, K du Preez, M Osman, Y Hirsch-Moverman, S Charalambous, H Hausler, A C Hesseling, G Hoddinott

Background: South Africa has one the highest TB and HIV burdens globally. TB preventive therapy (TPT) reduces the risk of TB disease and TB-related mortality in adults and children living with HIV and is indicated for use in TB-exposed HIV-negative individuals and children. TPT implementation in South Africa remains suboptimal.

Methods: We conducted a pragmatic review of TPT implementation using multiple data sources, including informant interviews (n = 134), semi-structured observations (n = 93) and TB patient folder reviews in 31 health facilities purposively selected across three high TB burden provinces. We used case descriptive analysis and thematic coding to identify barriers and facilitators to TPT implementation.

Results: TPT programme implementation was suboptimal, with inadequate monitoring even in health districts with well-functioning TB services. Health workers reported scepticism about TPT effectiveness, deprioritised TPT in practice and expressed divergent opinions about the cadres of staff responsible for implementation. Service- and facility-level barriers included ineffective contact tracing, resource shortages, lack of standardised reporting mechanisms and insufficient patient education on TPT. Patient-level barriers included socio-economic factors.

Conclusions: Improving TPT implementation will require radically simplified and more feasible systems and training for all cadres of health workers. Partnership with communities to stimulate demand driven service uptake can potentially facilitate implementation.

背景:南非是全球结核病和艾滋病毒负担最高的国家之一。结核病预防治疗(TPT)可降低感染艾滋病毒的成人和儿童患结核病和结核病相关死亡率的风险,并适用于暴露于结核病的艾滋病毒阴性个人和儿童。南非的TPT实施情况仍不理想。方法:我们使用多种数据来源对TPT实施情况进行了务实的回顾,包括信息者访谈(n = 134)、半结构化观察(n = 93)和结核病患者文件夹回顾,这些数据来自三个结核病高负担省份的31家卫生机构。我们使用案例描述性分析和主题编码来确定TPT实现的障碍和促进因素。结果:TPT规划的实施并不理想,即使在结核病服务运转良好的卫生区,监测也不充分。卫生工作者报告对TPT的有效性持怀疑态度,在实践中不重视TPT,并对负责执行的工作人员的干部表达了不同的意见。服务和设施层面的障碍包括接触者追踪无效、资源短缺、缺乏标准化报告机制以及TPT患者教育不足。患者层面的障碍包括社会经济因素。结论:改善TPT的实施需要从根本上简化和更可行的系统,并对所有卫生工作者干部进行培训。与社区建立伙伴关系,以刺激需求驱动的服务吸收,可能会促进实施。
{"title":"Reasons for poor uptake of TB preventive therapy in South Africa.","authors":"D P Baloyi,&nbsp;M G Anthony,&nbsp;K A Meyerson,&nbsp;S Mazibuko,&nbsp;D Wademan,&nbsp;L Viljoen,&nbsp;H Myburgh,&nbsp;K du Preez,&nbsp;M Osman,&nbsp;Y Hirsch-Moverman,&nbsp;S Charalambous,&nbsp;H Hausler,&nbsp;A C Hesseling,&nbsp;G Hoddinott","doi":"10.5588/pha.22.0030","DOIUrl":"https://doi.org/10.5588/pha.22.0030","url":null,"abstract":"<p><strong>Background: </strong>South Africa has one the highest TB and HIV burdens globally. TB preventive therapy (TPT) reduces the risk of TB disease and TB-related mortality in adults and children living with HIV and is indicated for use in TB-exposed HIV-negative individuals and children. TPT implementation in South Africa remains suboptimal.</p><p><strong>Methods: </strong>We conducted a pragmatic review of TPT implementation using multiple data sources, including informant interviews (<i>n</i> = 134), semi-structured observations (<i>n</i> = 93) and TB patient folder reviews in 31 health facilities purposively selected across three high TB burden provinces. We used case descriptive analysis and thematic coding to identify barriers and facilitators to TPT implementation.</p><p><strong>Results: </strong>TPT programme implementation was suboptimal, with inadequate monitoring even in health districts with well-functioning TB services. Health workers reported scepticism about TPT effectiveness, deprioritised TPT in practice and expressed divergent opinions about the cadres of staff responsible for implementation. Service- and facility-level barriers included ineffective contact tracing, resource shortages, lack of standardised reporting mechanisms and insufficient patient education on TPT. Patient-level barriers included socio-economic factors.</p><p><strong>Conclusions: </strong>Improving TPT implementation will require radically simplified and more feasible systems and training for all cadres of health workers. Partnership with communities to stimulate demand driven service uptake can potentially facilitate implementation.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"159-164"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716815/pdf/i2220-8372-12-4-159.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10603095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Caregivers' perspectives on health-related quality of life in young children with TB and respiratory illnesses. 照顾者对患有结核病和呼吸道疾病的幼儿健康相关生活质量的看法
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0038
M G Anthony, G Hoddinott, M Van Niekerk, A Mtshabe, A Pienaar, I Dewandel, C Mckenzie, P Goussard, A C Hesseling, M M van der Zalm

Background: There is a lack of holistic health-related quality of life (HRQoL) measures for young children with respiratory disease, especially in low- and middle-income countries (LMICs). We aimed to understand caregivers' perceptions of the relevance of common HRQoL domains for children with respiratory diseases, including TB.

Methods: This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of pulmonary TB. We conducted 10 semi-structured interviews to explore caregivers' perceptions of the five commonly measured HRQoL domains: physical health, social support, emotional and psychological wellbeing, and schooling. We used case descriptive analysis and thematic coding.

Results: Caregivers considered all five domains to be relevant. The socio-economic context framed their responses, with QoL requiring sufficient basic resources for children. HRQoL experiences varied according to the severity of the child's symptoms, but not between TB and non-TB illnesses. Manifestations in the psychological domain were difficult to distinguish from the emotional domain. Social support included broad support for family members, indirectly benefiting the children. Caregivers were concerned about their children's early developmental milestones and future schooling.

Conclusion: This exploratory study shows that HRQoL domains are relevant but require adaptation to be applicable for young children affected by respiratory illnesses living in LMICs.

背景:对于患有呼吸道疾病的幼儿,特别是在低收入和中等收入国家(LMICs),缺乏与健康相关的整体生活质量(HRQoL)测量。我们的目的是了解护理人员对包括结核病在内的呼吸系统疾病儿童常见HRQoL域相关性的看法。方法:本研究纳入了一组有呼吸道症状推定为肺结核的儿童的前瞻性观察队列。我们进行了10次半结构化访谈,以探讨护理人员对五个常用测量的HRQoL领域的看法:身体健康、社会支持、情感和心理健康以及学校教育。我们使用了案例描述性分析和主题编码。结果:护理者认为这五个领域都是相关的。社会经济背景决定了他们的反应,生活质量要求为儿童提供足够的基本资源。HRQoL经历根据儿童症状的严重程度而有所不同,但结核和非结核疾病之间没有差异。心理领域的表现很难与情感领域区分开来。社会支持包括对家庭成员的广泛支持,间接使儿童受益。看护人关心的是孩子的早期发展里程碑和未来的学校教育。结论:本探索性研究表明,HRQoL域是相关的,但需要适应,以适用于生活在低收入和中等收入国家的呼吸道疾病的幼儿。
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引用次数: 0
TB treatment non-adherence in São Tomé and Príncipe. <s:1> o tom<s:1>和Príncipe的结核病治疗不依从。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0040
S Bandeira, S da Trindade, M E Raguenaud, B Sousa

Setting: Sao Tomé and Principe (STP) is a lower middle-income country in the Gulf of Guinea that has a persistent high loss of TB patients on treatment.

Objective: To investigate factors associated with patient loss to follow-up (LTFU) and to assess health worker perceptions on non-adherence.

Design: A retrospective cohort study was conducted using data from the national database. Factors associated with LTFU were investigated using univariable and multivariable logistic regression. In-depth interviews were conducted with TB health workers to identify perceived barriers for treatment completion.

Results: A total of 822 registered patients with drug-susceptible TB were included, of whom 82 (10.0%) were lost to follow-up. Male sex (adjusted OR [aOR] 1.7, 95% CI 1.0-3.0; P = 0.048), as well as living in the Mé-Zóchi and Caué Districts (aOR 2.60, 95% CI 1.58-4.26; P < 0.001) were associated with an increased odds of LTFU. The main barriers to treatment completion were related to lack of food, stigma, and lack of patient information and personal support.

Conclusion: The study indicates the need to address multiple issues related to LTFU during TB treatment. Enhanced efforts to personalise care, especially for information, nutrition and encouragement will better support patients in STP.

背景:圣多美和普林西比(STP)是几内亚湾的一个中低收入国家,接受治疗的结核病患者持续大量流失。目的:调查与患者失访(LTFU)相关的因素,并评估卫生工作者对不依从性的看法。设计:使用国家数据库的数据进行回顾性队列研究。使用单变量和多变量logistic回归研究与LTFU相关的因素。与结核病卫生工作者进行了深入访谈,以确定完成治疗的感知障碍。结果:共纳入822例登记的药敏结核患者,其中失访82例(10.0%)。男性(调整OR [aOR] 1.7, 95% CI 1.0-3.0;P = 0.048),以及居住在Mé-Zóchi和cau地区(aOR 2.60, 95% CI 1.58-4.26;P < 0.001)与LTFU发生率增加相关。完成治疗的主要障碍与缺乏食物、耻辱感、缺乏患者信息和个人支持有关。结论:该研究表明,在结核病治疗过程中需要解决与LTFU相关的多个问题。加强个性化护理的努力,特别是在信息、营养和鼓励方面,将更好地支持STP患者。
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引用次数: 0
TB-related technical enquiries received in Japan, 2017-2019. 2017-2019年在日本收到的结核病相关技术咨询。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2022-12-21 DOI: 10.5588/pha.22.0053
M Urakawa, A Yasukawa, Y Hoshino, M Ota, H Hatamoto, S Hirao, T Zama, Y Nagata, T Yoshiyama

Setting: Japan, an intermediate TB burden country.

Objective: To review TB-related technical enquiries received at the Research Institute of Tuberculosis, Japan, from January 2017 to December 2019.

Design: This was a cohort study.

Results: A total of 2,197 enquiries were analysed. On average, 61.0 enquiries/month (range: 42-81) were received. The enquiry rates were highest for the Yamanashi (4.65/100,000 population) and Ishikawa (4.55) Prefectures, and lowest in the Yamagata (0.46) and Tochigi (0.56) Prefectures. The main organisations the enquirers belonged to were local governments (n = 1,585, 72.1%) and healthcare facilities (n = 307, 14.0%). The enquirers were medical doctors (n = 391, 17.8%), nurses (n = 1,207, 54.9%), other healthcare professionals (n = 57, 2.6%), the general public (n = 168, 7.6%) and others/unknown (n = 374, 17.0%). The most frequent enquiries were about TB diagnosis and treatment (n = 501, 22.8%), including laboratory diagnosis (n = 88, 4.0%), TB treatment in general (n = 93, 4.2%) and management of comorbidities (n = 86, 3.9%), followed by contact investigations (n = 385, 17.5%) and TB in foreigners (n = 344, 15.7%).

Conclusion: As the most frequent enquiries were about diagnosis and treatment of TB, the health ministry of Japan should maintain a few specialised TB institutions with TB physicians to provide technical assistance.

背景:日本,结核中间负担国。目的:回顾2017年1月至2019年12月日本结核病研究所收到的结核病相关技术咨询。设计:这是一项队列研究。结果:共分析了2197份查询。平均每月接获61.0宗查询(介乎42至81宗)。问询率最高的是山梨县(4.65/10万)和石川县(4.55 /10万),最低的是山形县(0.46 /10万)和枥木县(0.56 /10万)。询问者主要来自地方政府(1585人,占72.1%)和医疗机构(307人,占14.0%)。询问者为医生(n = 391, 17.8%)、护士(n = 1207, 54.9%)、其他保健专业人员(n = 57, 2.6%)、普通公众(n = 168, 7.6%)和其他/未知人员(n = 3774, 17.0%)。最常见的问询是结核病的诊断和治疗(n = 501, 22.8%),包括实验室诊断(n = 88, 4.0%)、一般结核病治疗(n = 93, 4.2%)和合并症的管理(n = 86, 3.9%),其次是接触者调查(n = 385, 17.5%)和外国人结核病(n = 344, 15.7%)。结论:由于最常见的咨询是关于结核病的诊断和治疗,日本厚生劳动省应保留一些专门的结核病机构,配备结核病医生,以提供技术援助。
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引用次数: 1
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Public Health Action
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