W Toua, V Lape, J W Bolnga, M Daimen, T Kelebi, S Vaccher, J Greig
{"title":"在巴布亚新几内亚马当省观察到结核病治疗效果不佳的高发率。","authors":"W Toua, V Lape, J W Bolnga, M Daimen, T Kelebi, S Vaccher, J Greig","doi":"10.5588/pha.24.0015","DOIUrl":null,"url":null,"abstract":"<p><strong>Setting: </strong>Madang Province is located on the northern coast of Papua New Guinea (PNG), a critical mixing point between the populous highlands and more remote regions. Madang Province faces challenges with limited capacity to diagnose and treat TB.</p><p><strong>Objective: </strong>To describe the TB caseload and investigate factors associated with known unfavourable treatment outcomes.</p><p><strong>Design: </strong>This is a retrospective cohort study using routinely collected TB programmatic data for treatments commenced 1 January 2019 to 31 December 2021. Using multivariable logistic regression, factors associated with known unfavourable treatment outcomes-death, failure after treatment, and loss to follow-up (LTFU)-were evaluated.</p><p><strong>Results: </strong>Of the 4,668 registered and treated, 3,755 had an evaluated outcome, and 33% had unfavourable outcomes, most commonly LTFU (23%). Unfavourable treatment outcomes were significantly associated with HIV-untested (aOR 2.82 compared to HIV-negative; 95% CI 2.39-3.33), having drug-resistant TB (aOR 3.26 compared to drug-susceptible TB, 95% CI 1.18-9.00), and travel time to the health facility 1-<3 hours by foot (aOR 3.53 compared to <1 hour by foot; 95% CI 1.04-12.06).</p><p><strong>Conclusion: </strong>High LTFU from TB treatment was associated with factors that indicate barriers to access to care and treatment completion. Decentralisation and strengthening of TB services for improved person-centred care and treatment support are urgently required in Madang Province.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373745/pdf/","citationCount":"0","resultStr":"{\"title\":\"High rates of unfavourable TB treatment outcomes observed in Madang Province, Papua New Guinea.\",\"authors\":\"W Toua, V Lape, J W Bolnga, M Daimen, T Kelebi, S Vaccher, J Greig\",\"doi\":\"10.5588/pha.24.0015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Setting: </strong>Madang Province is located on the northern coast of Papua New Guinea (PNG), a critical mixing point between the populous highlands and more remote regions. Madang Province faces challenges with limited capacity to diagnose and treat TB.</p><p><strong>Objective: </strong>To describe the TB caseload and investigate factors associated with known unfavourable treatment outcomes.</p><p><strong>Design: </strong>This is a retrospective cohort study using routinely collected TB programmatic data for treatments commenced 1 January 2019 to 31 December 2021. Using multivariable logistic regression, factors associated with known unfavourable treatment outcomes-death, failure after treatment, and loss to follow-up (LTFU)-were evaluated.</p><p><strong>Results: </strong>Of the 4,668 registered and treated, 3,755 had an evaluated outcome, and 33% had unfavourable outcomes, most commonly LTFU (23%). Unfavourable treatment outcomes were significantly associated with HIV-untested (aOR 2.82 compared to HIV-negative; 95% CI 2.39-3.33), having drug-resistant TB (aOR 3.26 compared to drug-susceptible TB, 95% CI 1.18-9.00), and travel time to the health facility 1-<3 hours by foot (aOR 3.53 compared to <1 hour by foot; 95% CI 1.04-12.06).</p><p><strong>Conclusion: </strong>High LTFU from TB treatment was associated with factors that indicate barriers to access to care and treatment completion. Decentralisation and strengthening of TB services for improved person-centred care and treatment support are urgently required in Madang Province.</p>\",\"PeriodicalId\":46239,\"journal\":{\"name\":\"Public Health Action\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373745/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Public Health Action\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5588/pha.24.0015\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Public Health Action","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5588/pha.24.0015","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
摘要
背景马当省位于巴布亚新几内亚(PNG)北部海岸,是人口众多的高原地区与较偏远地区的重要交汇点。马当省面临着结核病诊断和治疗能力有限的挑战:描述肺结核病例数,调查与已知不利治疗结果相关的因素:这是一项回顾性队列研究,使用的是例行收集的肺结核项目数据,涉及的是 2019 年 1 月 1 日至 2021 年 12 月 31 日开始的治疗。通过多变量逻辑回归,评估了与已知不利治疗结果--死亡、治疗失败和失去随访(LTFU)--相关的因素:在登记并接受治疗的 4,668 人中,3,755 人获得了评估结果,33% 的人获得了不利结果,其中最常见的是 LTFU(23%)。不利的治疗结果与 HIV 检测未通过(与 HIV 检测阴性相比,aOR 值为 2.82;95% CI 为 2.39-3.33)、耐药结核病(与药敏结核病相比,aOR 值为 3.26;95% CI 为 1.18-9.00)以及前往医疗机构的旅行时间密切相关:结核病治疗的高延迟率与一些因素有关,这些因素表明在获得医疗服务和完成治疗方面存在障碍。马当省亟需下放权力并加强结核病服务,以改善以人为本的护理和治疗支持。
High rates of unfavourable TB treatment outcomes observed in Madang Province, Papua New Guinea.
Setting: Madang Province is located on the northern coast of Papua New Guinea (PNG), a critical mixing point between the populous highlands and more remote regions. Madang Province faces challenges with limited capacity to diagnose and treat TB.
Objective: To describe the TB caseload and investigate factors associated with known unfavourable treatment outcomes.
Design: This is a retrospective cohort study using routinely collected TB programmatic data for treatments commenced 1 January 2019 to 31 December 2021. Using multivariable logistic regression, factors associated with known unfavourable treatment outcomes-death, failure after treatment, and loss to follow-up (LTFU)-were evaluated.
Results: Of the 4,668 registered and treated, 3,755 had an evaluated outcome, and 33% had unfavourable outcomes, most commonly LTFU (23%). Unfavourable treatment outcomes were significantly associated with HIV-untested (aOR 2.82 compared to HIV-negative; 95% CI 2.39-3.33), having drug-resistant TB (aOR 3.26 compared to drug-susceptible TB, 95% CI 1.18-9.00), and travel time to the health facility 1-<3 hours by foot (aOR 3.53 compared to <1 hour by foot; 95% CI 1.04-12.06).
Conclusion: High LTFU from TB treatment was associated with factors that indicate barriers to access to care and treatment completion. Decentralisation and strengthening of TB services for improved person-centred care and treatment support are urgently required in Madang Province.
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.