结核病延迟和结核病治疗结果在HIV-TB同时感染的患者之间的关联:基于多级倾向得分方法的研究
Rujun Liao1,2, Lin Hu3, Jie Yu3
1Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
BMC infectious diseases
|April 30, 2024
概括
在HIV-TB同时感染的患者中,结核病 (TB) 诊断和治疗的延迟显著增加了治疗不良结果的风险. 改善医疗保健系统以加快诊断和治疗对于更好的患者结果至关重要.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 流行病学 流行病学
背景情况:
- 艾滋病毒 - 结核病 (HIV-TB) 联合感染是一个重大的全球卫生挑战.
- 结核病护理的延迟,包括患者,诊断和治疗阶段,与较差的抗结核病治疗 (ATT) 结果有关.
- 区域因素可以影响ATT的结果,但很少有研究充分解决了个别和区域的混变量.
研究的目的:
- 评估中国梁山县HIV-TB同时感染患者的结核病延迟和治疗结果之间的关联.
- 采用因果推理框架,考虑个人和区域的混因素.
主要方法:
- 分析了2068名在梁山县同时感染艾滋病毒和结核病的患者 (2019-2022) 的数据.
- 使用因果定向非循环图 (DAG) 来识别和控制混变量.
- 应用多层倾向得分和反向概率权重 (IPW) 来减轻偏差.
主要成果:
- 艾滋病毒-结核病同时感染患者的ATT成功率为91.2%.
- 总延迟 (OR=1.411),诊断延迟 (OR=1.778),治疗延迟 (OR=1.749) 和卫生系统延迟 (OR=1.480) 是不利的ATT结果的重要风险因素.
- 敏感性分析证实了这些发现的可靠性.
结论:
- 对被诊断为HIV-TB同时感染患者的早期治疗优先考虑,对于梁山县的预防和控制政策至关重要.
- 需要紧急改善医疗保健系统,以减少艾滋病毒-结核病同时感染患者的诊断和治疗延迟.
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