进入初级保健机构的结核患者高死亡率:从一个开放标签集群随机试验中进行的二次分析
Kogieleum Naidoo1, Nonhlanhla Yende Zuma2,3, Mikaila Moodley2
1Centre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa.
EClinicalMedicine
|April 1, 2025
概括
质量改善干预措施没有显著减少南非初级医疗保健中的结核病 (TB) 死亡率. 不接受抗逆转录病毒治疗的人群中,结核病例死亡率较高.
科学领域:
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 结核病 (TB) 仍然是全球主要的死亡原因,需要有效的控制策略.
- 初级卫生保健 (PHC) 服务对于治疗结核病患者至关重要.
- 评估干预措施,以减少结核病死亡率在PHC设置是至关重要的.
研究的目的:
- 评估质量改善 (QI) 干预对结核病患者死亡率的影响.
- 确定在PHC环境中实施QI是否会降低18个月病例死亡率 (CFR).
主要方法:
- 在南非 (2016-2018) 进行的一项集群随机对照研究.
- 在QI干预诊所和标准护理 (SOC) 诊所的新诊断结核病患者中,比较了18个月的CFR.
- 用了两阶段的统计方法对集群随机试验,每臂<15个集群.
主要成果:
- 在QI干预 (9.5%) 和SOC (11.3%) 之间18个月结核病CFR没有显著差异.
- 在5817名新确诊的结核病患者中,整体CFR为9.7%.
- 在艾滋病毒/艾滋病 (PLWHA) 感染者,非抗逆转录病毒治疗 (ART) 患者和艾滋病毒-结核病共感染患者中观察到更高的CFR.
结论:
- 在这个PHC环境中,QI干预并没有显著降低结核病死亡率.
- 结核病CFR在不接受ART的PLWHA和HIV-TB共感染个体中显著更高.
- 对于高风险结核病患者群体,需要进一步制定有针对性的策略.
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