Initiation, scale-up and outcomes of the Cambodian National MDR-TB programme 2006–2016: hospital and community-based treatment through an NGO–NTP partnership
| Autor: | Anne E. Goldfeld, Rassi So, Sokhan Khann, Prum Chhom Sayouen, Bonamy Koy, Sophan Sam, Sarith Noun, Adrienne E Shapiro, Tan Eang Mao, Sokhem Chhun, Heng Bunsieth, Thim Sok, Chun Im Sin, Sopheap Khem |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Tuberculosis 030231 tropical medicine 03 medical and health sciences 0302 clinical medicine Acquired immunodeficiency syndrome (AIDS) Medicine Community health workers In patient 030212 general & internal medicine Community based multi-drug resistant-TB business.industry medicine.disease Regimen General partnership Family medicine HIV/AIDS business Cambodia Body mass index community-based treatment |
| Zdroj: | BMJ Open Respiratory Research |
| ISSN: | 2052-4439 |
| Popis: | IntroductionProlonged inpatient multidrug-resistant tuberculosis (MDR-TB) treatment for all patients is not sustainable for high-burden settings, but there is limited information on community-based treatment programme outcomes for MDR-TB.MethodsThe Cambodian Health Committee, a non-governmental organisation (NGO), launched the Cambodian MDR-TB programme in 2006 in cooperation with the National Tuberculosis Program (NTP) including a community-based treatment option as a key programme component. The programme was transferred to NTP oversight in 2011 with NGO clinical management continuing. Patients electing to receive home-based treatment were followed by a dedicated adherence supporter and a multidisciplinary outpatient team of nurses, physicians and community health workers. Patients hospitalised for >1 month of treatment (hospital based) received similar management after discharge. All patients received a standardised second-line MDR-TB regimen and were provided nutritional and adherence support. Outcomes were reviewed for patients completing 24 months of treatment and predictors of treatment success were evaluated using logistic regression.ResultsOf 582 patients with MDR-TB who initiated treatment between September 2006 and June 2016, 20% were HIV coinfected, 288 (49%) initiated community-based treatment and 294 (51%) received hospital-based treatment. Of 486 patients with outcomes available, 364 (75%) were cured, 10 (2%) completed, 28 (6%) were lost to follow-up, 3 (0.6%) failed and 77 (16%) died. There was no difference between treatment success in community versus hospital-based groups (adjusted OR (aOR) 1.0, p=0.99). HIV infection, older age and body mass index ConclusionsCambodia’s NGO–NTP partnership successfully developed and scaled up a model MDR-TB treatment programme. The first large-scale MDR-TB programme in Asia with a significant community-based component, the programme achieved equally high treatment success in patients with community-based compared with hospital-based initiation of MDR treatment. |
| Databáze: | OpenAIRE |
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