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Early Outcomes of Decentralized Care for Rifampicin-Resistant Tuberculosis in Johannesburg, South Africa: An Observational Cohort Study

机译：南非约翰内斯堡分散治疗利福平耐药结核病的早期结果：一项观察性队列研究

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OBJECTIVE:\udWe describe baseline characteristics, time to treatment initiation and interim patient outcomes at a decentralized, outpatient treatment site for rifampicin-resistant TB (RR-TB).\udMETHODS:\udProspective observational cohort study of RR-TB patients from March 2013 until December 2014. Study subjects were followed until completion of the intensive phase of treatment (6 months), transfer out, or a final outcome (loss from treatment (LFT) or death).\ud\udRESULTS:\ud214 patients with RR-TB were enrolled in the study. Xpert MTB/RIF was the diagnostic test of rifampicin resistance for 87% (n = 186), followed by direct PCR on AFB positive specimen in 14 (7%) and indirect PCR on cultured isolate in 5 (2%). Median time between sputum testing and treatment initiation was 10 days (IQR 6-21). Interim outcomes were available in 148 patients of whom 78% (n = 115) were still on treatment, 9% (n = 13) had died, and 14% (n = 20) were LFT. Amongst 131 patients with culture positive pulmonary TB, 85 (64.9%) were culture negative at 6 months, 12 were still sputum culture positive (9.2%) and 34 had no culture documented or contaminated culture (26%). Patients who initiated as outpatients within 1 week of sputum collection for diagnosis of RR-TB had a significantly lower incidence of LFT (IRR 0.30, 95% CI: 0.09-0.98). HIV co-infection occurred in 178 patients (83%) with a median CD4 count 88 cells/ml3 (IQR 27-218).\ud\udCONCLUSIONS:\udAccess to decentralized treatment coupled with the rapid diagnosis of RR-TB has resulted in short time to treatment initiation. Despite the lack of treatment delays, early treatment outcomes remain poor with high rates of death and loss from care.
机译：目的：\ ud我们描述了利福平耐药结核病（RR-TB）在分散的门诊治疗地点的基线特征，开始治疗的时间和中期患者的结局。\ udMETHODS：\ ud自2013年3月起对RR-TB患者进行的前瞻性观察性队列研究直到2014年12月。研究对象一直被追踪到完成强化治疗阶段（6个月），转移或最终结果（治疗损失（LFT）或死亡）。\ ud \ ud结果：\ ud214 RR-患者结核被纳入研究。 Xpert MTB / RIF是对利福平的耐药性的诊断测试，诊断率为87％（n = 186），然后对AFB阳性标本进行直接PCR检测的率为14（7％），对培养的分离株进行间接PCR检测率为5（2％）。痰液测试和治疗开始之间的中位时间为10天（IQR 6-21）。 148例患者可获得中期结果，其中78％（n = 115）仍在接受治疗，9％（n = 13）死亡，LFT占14％（n = 20）。在131例肺结核培养阳性的患者中，有85例（64.9％）在6个月时培养阴性，还有12例痰培养阳性（9.2％），还有34例无培养记录或污染的培养（26％）。在痰收集后1周内开始门诊以诊断RR-TB的患者的LFT发生率显着降低（IRR 0.30，95％CI：0.09-0.98）。 HIV共感染发生在178名患者中（83％），其CD4计数中位数为88细胞/ ml3（IQR 27-218）。\ ud \ ud结论：\ ud获得分散治疗并快速诊断RR-TB已导致治疗开始时间短。尽管没有延迟治疗，但早期治疗的结果仍然很差，死亡率和护理损失率很高。

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