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社区支持的自行治疗结核病,结合活跃结核病查:在几内亚科纳克里开展试点实验
Souleymane Hassane-Harouna1, Tinne Gils2,3, Tom Decroo2
1Tuberculosis department, Damien Foundation, Conakry, Guinea.
Global health action
|October 6, 2023
概括
在几内亚,社区支持的自我治疗 (CS-SAT) 取得了高结核病 (TB) 治疗成功. 该模型还促进了在具有挑战性的环境中发现活跃的结核病例和推送异化物预防治疗 (IPT).
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 全球健康 全球健康
背景情况:
- 直接观察治疗 (DOT) 是世卫组织推的结核病 (TB),但在患者偏好,医疗负担和在不稳定的环境中实施方面面临挑战.
- 几内亚是一个高结核病负担的国家,经历了反复的流行病和社会政治动荡,使传统的DOT变得困难.
- 社区支持的自给治疗 (CS-SAT) 提供了一个替代方案,通过让社区成员参与支持自给结核病药物治疗的患者.
研究的目的:
- 试点并评估CS-SAT模型对几内亚科纳克里药物敏感结核病患者的有效性.
- 评估结核病治疗结果,包括治疗成功,失败,死亡和对随访的损失.
- 量化CS-SAT模型在家庭接触者中发现活跃结核病例的影响,并为五岁以下的儿童提供异化物预防性治疗 (IPT).
主要方法:
- 一项前性试点研究招募了经细菌学确认的结核病患者,他们在科纳克里两个设施每月接受药物治疗.
- 社区志愿者每两周进行一次 (入门),然后每月一次 (继续) 的家庭访问,以监测遵守,检查结核病接触者,并评估IPT的吸收.
- 收集了有关患者人口统计,治疗结果,结核病例发现和IPT转诊的数据.
主要成果:
- 在359名注册结核病患者中,94.7%的患者获得了治疗成功,死亡率低 (1.9%),治疗失败 (1.9%) 和随访损失 (1.4%).
- 在1585名经过查的家庭接触者中,积极结核病例发现发现了26名结核病症状的个人,导致了5名新的肺结核诊断.
- 来自198个家庭的5岁以下的376名儿童提供了IPT转诊.
结论:
- 几内亚的CS-SAT模型在具有挑战性的环境中显示出高的结核病治疗成功率,而DOT通常是不可行的.
- CS-SAT提供了一个可行的替代方案,增强患者的坚持,并为关键的公共卫生干预提供机会,如结核病例发现和IPT.
- 该模型推用于在面临医疗保健获取挑战和高结核病负担的类似环境中实施.
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