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地点:南非夸祖鲁纳塔尔赫拉比萨卫生服务分区。目的:描述纳入区级结核病防治规划的以社区为基础的耐多药结核病(MDR-TB)治疗管理模式的建立,并评价此模式下患者早期治疗转归是否可以与传统的住院治疗关怀模式相比。设计:将2008年3—12月间在社区管理模式(CM)下开始接受耐多药结核病治疗的患者与2001年1月至2008年2月间在传统住院治疗关怀模式(TM)下开始接受耐多药结核病治疗的患者进行对比。运用Mantel-Cox long-rank检验在Kaplan-Merier生存曲线中比较2组患者开始治疗的时间、痰涂片和痰培养阴转的时间。摘要结果:共纳入50例CM患者和57例TM患者;50例CM患者中有39例(78.0%)为人类免疫缺陷病毒(HIV)阳性。CM患者开始治疗的中位时间是84 d,TM患者开始治疗的中位时间是106.5 d(P=0.002)。CM患者痰涂片阴转的中位时间比TM患者短(59 d对92 d,P=0.055),痰培养阴转的中位时间也是如此(85 d对119 d,P=0.002)。结论:以社区为基础的耐多药结核病治疗管理模式在南非农村地区现有的结核病防治规划中是可行的,应在资源允许的地区进行推广。
Location: KwaZulu-Natal, South Africa Hera Pisa District of Health Services. OBJECTIVE: To describe the establishment of a community-based multidrug-resistant tuberculosis (MDR-TB) treatment management model that incorporates a district-based TB prevention and control program and to assess whether early treatment outcomes associated with this modality can be compared with traditional inpatient care delivery patterns ratio. Design: Patients who started treatment with MDR-TB in community management mode (CM) during the period from March to December 2008 and patients who started treatment in the traditional inpatient care mode (TM) between January 2001 and February 2008 MDR-TB patients were compared. Mantel-Cox long-rank test was used to compare the time to start treatment, sputum smear and sputum culture in Kaplan-Merier survival curves in two groups. Summary Results: A total of 50 CM patients and 57 TM patients were enrolled; 39 of 50 CM patients (78.0%) were human immunodeficiency virus (HIV) positive. The median time to start treatment was 84 days in CM patients and 106.5 days in TM patients (P = 0.002). The median time to negative conversion of sputum smears was shorter in CM patients than in TM patients (59 d vs 92 d, P = 0.055), as was the median time to sputum culture (85 days vs 119 days, P = 0.002). CONCLUSIONS: Community-based MDR-TB management approaches are feasible in existing TB programs in rural South Africa and should be promoted where resources permit.