Predictors of treatment delay among drug resistant tuberculosis patients in Uganda.

IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES
Nabukenya Diana Kasozi, Lwanga Charles, Asiimwe JohnBosco, Luzze Henry
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Abstract

Background: Drug resistant tuberculosis (DR-TB) continues to be a significant global public health concern despite the availability of effective TB medicines. Equally, delayed DR-TB treatment initiation is associated with increased morbidity, amplified resistance, transmission risk and poor treatment outcomes. This study aimed to investigate treatment delays and identify predictors of delayed treatment initiation among DR-TB patients in Uganda.

Method: A retrospective study was conducted using routine DR-TB national case registration data between January 2012 and December 2019. Stata version 15 was used to run uni-variate analysis to describe patient characteristics using frequencies and percentages; bivariate analysis to identify significant differences in median times to treatment initiation; and logistic regression model was fitted, and adjusted odds ratio (AOR) with 95% confidence interval was used to identify factors associated with DR-TB treatment delay.

Results: A total of 2,166 DR-TB patients were included in this study. The median treatment initiation delay was 10 days. Approximately 57% of DR-TB patients experienced delays in starting their treatment beyond the acceptable 7-day timeframe. Being diagnosed as RR-TB [AOR = 1.22; 95% CI: 1.08-1.37], and being a recurrent TB patient [AOR = 1.22; 95% CI: 1.01-1.47] were associated with treatment delays. Patients with previous history of 'lost to follow-up' (LTFU), failure and being diagnosed as Pre-XDR-TB were less inclined to delay DR-TB treatment.

Conclusion: Several DR-TB patients experienced treatment delay. The delay was significant among patients diagnosed as RR-TB and those with TB treatment history of recurrent TB. This highlights the need for heightened vigilance among healthcare workers when managing DR-TB patients with a history of past TB treatment and those diagnosed as RR-TB to minimize delays. Furthermore, future research should investigate a comprehensive list of variables influencing the timing of treatment initiation after diagnosis. An in-depth understanding of the effects of these factors can inform targeted interventions to optimize treatment strategies for improved DR-TB patient outcomes.

乌干达耐药结核病患者治疗延误的预测因素。
背景:尽管有有效的结核病药物,但耐药结核病(DR-TB)仍然是一个重大的全球公共卫生问题。同样,延迟开始耐药结核病治疗与发病率增加、耐药性增强、传播风险和治疗结果不佳有关。本研究旨在调查乌干达耐多药结核病患者的治疗延迟和确定延迟开始治疗的预测因素。方法:利用2012年1月至2019年12月的耐药结核病国家病例登记数据进行回顾性研究。使用Stata version 15进行单变量分析,使用频率和百分比描述患者特征;双变量分析以确定开始治疗的中位数时间的显著差异;拟合logistic回归模型,采用95%置信区间的校正优势比(AOR)确定与耐药结核病治疗延误相关的因素。结果:本研究共纳入2166例耐药结核病患者。治疗开始延迟的中位数为10天。大约57%的耐药结核病患者在超过可接受的7天时间框架后才开始治疗。被诊断为RR-TB [AOR = 1.22;95% CI: 1.08-1.37],且为复发结核患者[AOR = 1.22;95% CI: 1.01-1.47]与治疗延误有关。既往有“失访”史、失败史和被诊断为前广泛耐药结核的患者不太倾向于延迟耐药结核治疗。结论:多例耐药结核病患者出现治疗延误。在诊断为RR-TB的患者和有复发性TB治疗史的患者中,延迟显著。这突出表明卫生保健工作者在管理有结核病治疗史的耐药结核病患者和被诊断为耐药结核病的患者时需要提高警惕,以尽量减少延误。此外,未来的研究应该调查影响诊断后开始治疗时间的变量的综合列表。深入了解这些因素的影响可以为有针对性的干预措施提供信息,以优化治疗策略,改善耐药结核病患者的预后。
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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来源期刊
BMC Infectious Diseases
BMC Infectious Diseases 医学-传染病学
CiteScore
6.50
自引率
0.00%
发文量
860
审稿时长
3.3 months
期刊介绍: BMC Infectious Diseases is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology.
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