Vulika Nangombe, Mondjila Amkongo, Brian Godman, Dan Kibuule
{"title":"纳米比亚耐药结核病治疗成功的预测因素。","authors":"Vulika Nangombe, Mondjila Amkongo, Brian Godman, Dan Kibuule","doi":"10.1093/jacamr/dlae211","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant tuberculosis (DR-TB) is a considerable barrier to ending TB globally by 2035. In most high TB-burden countries in the sub-Saharan region, drivers of DR-TB treatment success are unknown.</p><p><strong>Objectives: </strong>To determine predictors and patterns of treatment success rates (TSRs) in DR-TB in Namibia to inform strategies of national TB programmes.</p><p><strong>Methods: </strong>A nationwide retrospective observational cohort study of a 6 year DR-TB database, 2014-19, was carried out. Independent predictors of successful treatment outcome in DR-TB were determined by multivariate logistic regression.</p><p><strong>Results: </strong>Of the 1494 DR-TB patients included, 56.3% (<i>n</i> = 841) were male, the mean (±SD) age was 35.6 ± 14.2 years, and 8.3% had TB/HIV coinfection. The overall TSR was 66.5% (<i>n</i> = 994) and it increased marginally between implementation of the second and third medium-term plans for TB and leprosy (MTP-II and MTP-III). Being female was associated with lower odds of treatment success [adjusted OR (aOR) = 0.6; 95% CI: 0.34-0.89; <i>P =</i> 0.015), as was a young age (under 5 years) (aOR = 0.1; 95% CI: 0.0007-0.421; <i>P =</i> 0.005) and ages of 5-14 years (aOR = 0.0; 95% CI: 0.002-0.269; <i>P =</i> 0.002). Namibian nationality also showed a reduced likelihood of treatment success (aOR = 0.3; 95% CI: 0.089-0.961; <i>P =</i> 0.043). Among clinical predictors, bilateral pulmonary forms were inversely associated with treatment success (aOR = 0.2; 95% CI: 0.057-0.498; <i>P =</i> 0.001). Conversely, baseline monoresistance was linked to an increased likelihood of treatment success (aOR = 7.6; 95% CI: 1.427-40.631; <i>P =</i> 0.018).</p><p><strong>Conclusions: </strong>Whilst DR-TB TSRs improved, they are below the global target and vary by clinical and patient demographics. Targeted interventions for high-risk patients, including female patients, those aged under 15 years, locals and those with bilateral pulmonary disease using community-based approaches to boost adherence, alongside leveraging the skills of clinical pharmacists, should now be explored.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae211"},"PeriodicalIF":3.7000,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086688/pdf/","citationCount":"0","resultStr":"{\"title\":\"Drug-resistant tuberculosis treatment success predictors in Namibia.\",\"authors\":\"Vulika Nangombe, Mondjila Amkongo, Brian Godman, Dan Kibuule\",\"doi\":\"10.1093/jacamr/dlae211\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Drug-resistant tuberculosis (DR-TB) is a considerable barrier to ending TB globally by 2035. In most high TB-burden countries in the sub-Saharan region, drivers of DR-TB treatment success are unknown.</p><p><strong>Objectives: </strong>To determine predictors and patterns of treatment success rates (TSRs) in DR-TB in Namibia to inform strategies of national TB programmes.</p><p><strong>Methods: </strong>A nationwide retrospective observational cohort study of a 6 year DR-TB database, 2014-19, was carried out. Independent predictors of successful treatment outcome in DR-TB were determined by multivariate logistic regression.</p><p><strong>Results: </strong>Of the 1494 DR-TB patients included, 56.3% (<i>n</i> = 841) were male, the mean (±SD) age was 35.6 ± 14.2 years, and 8.3% had TB/HIV coinfection. The overall TSR was 66.5% (<i>n</i> = 994) and it increased marginally between implementation of the second and third medium-term plans for TB and leprosy (MTP-II and MTP-III). Being female was associated with lower odds of treatment success [adjusted OR (aOR) = 0.6; 95% CI: 0.34-0.89; <i>P =</i> 0.015), as was a young age (under 5 years) (aOR = 0.1; 95% CI: 0.0007-0.421; <i>P =</i> 0.005) and ages of 5-14 years (aOR = 0.0; 95% CI: 0.002-0.269; <i>P =</i> 0.002). Namibian nationality also showed a reduced likelihood of treatment success (aOR = 0.3; 95% CI: 0.089-0.961; <i>P =</i> 0.043). Among clinical predictors, bilateral pulmonary forms were inversely associated with treatment success (aOR = 0.2; 95% CI: 0.057-0.498; <i>P =</i> 0.001). Conversely, baseline monoresistance was linked to an increased likelihood of treatment success (aOR = 7.6; 95% CI: 1.427-40.631; <i>P =</i> 0.018).</p><p><strong>Conclusions: </strong>Whilst DR-TB TSRs improved, they are below the global target and vary by clinical and patient demographics. Targeted interventions for high-risk patients, including female patients, those aged under 15 years, locals and those with bilateral pulmonary disease using community-based approaches to boost adherence, alongside leveraging the skills of clinical pharmacists, should now be explored.</p>\",\"PeriodicalId\":14594,\"journal\":{\"name\":\"JAC-Antimicrobial Resistance\",\"volume\":\"6 6\",\"pages\":\"dlae211\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-12-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086688/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAC-Antimicrobial Resistance\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/jacamr/dlae211\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAC-Antimicrobial Resistance","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/jacamr/dlae211","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Drug-resistant tuberculosis treatment success predictors in Namibia.
Background: Drug-resistant tuberculosis (DR-TB) is a considerable barrier to ending TB globally by 2035. In most high TB-burden countries in the sub-Saharan region, drivers of DR-TB treatment success are unknown.
Objectives: To determine predictors and patterns of treatment success rates (TSRs) in DR-TB in Namibia to inform strategies of national TB programmes.
Methods: A nationwide retrospective observational cohort study of a 6 year DR-TB database, 2014-19, was carried out. Independent predictors of successful treatment outcome in DR-TB were determined by multivariate logistic regression.
Results: Of the 1494 DR-TB patients included, 56.3% (n = 841) were male, the mean (±SD) age was 35.6 ± 14.2 years, and 8.3% had TB/HIV coinfection. The overall TSR was 66.5% (n = 994) and it increased marginally between implementation of the second and third medium-term plans for TB and leprosy (MTP-II and MTP-III). Being female was associated with lower odds of treatment success [adjusted OR (aOR) = 0.6; 95% CI: 0.34-0.89; P = 0.015), as was a young age (under 5 years) (aOR = 0.1; 95% CI: 0.0007-0.421; P = 0.005) and ages of 5-14 years (aOR = 0.0; 95% CI: 0.002-0.269; P = 0.002). Namibian nationality also showed a reduced likelihood of treatment success (aOR = 0.3; 95% CI: 0.089-0.961; P = 0.043). Among clinical predictors, bilateral pulmonary forms were inversely associated with treatment success (aOR = 0.2; 95% CI: 0.057-0.498; P = 0.001). Conversely, baseline monoresistance was linked to an increased likelihood of treatment success (aOR = 7.6; 95% CI: 1.427-40.631; P = 0.018).
Conclusions: Whilst DR-TB TSRs improved, they are below the global target and vary by clinical and patient demographics. Targeted interventions for high-risk patients, including female patients, those aged under 15 years, locals and those with bilateral pulmonary disease using community-based approaches to boost adherence, alongside leveraging the skills of clinical pharmacists, should now be explored.
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