PDF(Pubmed)
Abstract：
UNASSIGNED: In Indonesia, drug resistance testing for TB largely relies on Xpert MTB/RIF, and it is unknown what proportion of drug-resistant (DR) TB is adequately diagnosed and treated.
UNASSIGNED: We conducted a cascade of care analysis on a cohort of presumptive rifampicin-resistant (RR) TB patients registered in 2015-2018 in a tertiary hospital in Indonesia. Estimated incidences of (presumptive) DR-TB cases were assumption-based using global reports. Data on diagnosis and consecutive cascades steps, including their timing were collected from national electronic registers, and medical records. We described a secondary cascade for patients receiving treatment not supported by phenotypic drug susceptibility testing (pDST). Factors associated with delay and loss between diagnosis and treatment were identified using logistic regression.
UNASSIGNED: Less than a third of estimated incident TB cases at risk of DR-TB were identified as presumptive DR-TB case and tested, and 9.8% (982/10,065) of estimated true DR-TB cases was diagnosed. Of those diagnosed, only 45.1% (443/982) had treatment regimens supported by pDST results, but this did not significantly influence treatment outcomes. Only 25.5% (250/982) of diagnosed patients completed all steps of the cascade including successful treatment. Delays between diagnosis and treatment were substantial, and more common among those referred from a primary healthcare facility, and among those who were employed, living outside of Bandung, and reporting engagement with the private sector.
UNASSIGNED: The DR-TB care cascade in this urban setting in Indonesia is characterized by substantial attrition and delays. Strategies to increase access to DR-TB diagnosis accompanied by optimisation of clinical care could substantially improve outcomes and reduce onward transmission.
UNASSIGNED: Radboud university medical center and University of Otago.
UNASSIGNED: We conducted a cascade of care analysis on a cohort of presumptive rifampicin-resistant (RR) TB patients registered in 2015-2018 in a tertiary hospital in Indonesia. Estimated incidences of (presumptive) DR-TB cases were assumption-based using global reports. Data on diagnosis and consecutive cascades steps, including their timing were collected from national electronic registers, and medical records. We described a secondary cascade for patients receiving treatment not supported by phenotypic drug susceptibility testing (pDST). Factors associated with delay and loss between diagnosis and treatment were identified using logistic regression.
UNASSIGNED: Less than a third of estimated incident TB cases at risk of DR-TB were identified as presumptive DR-TB case and tested, and 9.8% (982/10,065) of estimated true DR-TB cases was diagnosed. Of those diagnosed, only 45.1% (443/982) had treatment regimens supported by pDST results, but this did not significantly influence treatment outcomes. Only 25.5% (250/982) of diagnosed patients completed all steps of the cascade including successful treatment. Delays between diagnosis and treatment were substantial, and more common among those referred from a primary healthcare facility, and among those who were employed, living outside of Bandung, and reporting engagement with the private sector.
UNASSIGNED: The DR-TB care cascade in this urban setting in Indonesia is characterized by substantial attrition and delays. Strategies to increase access to DR-TB diagnosis accompanied by optimisation of clinical care could substantially improve outcomes and reduce onward transmission.
UNASSIGNED: Radboud university medical center and University of Otago.
摘要：
■在印度尼西亚，结核病的耐药性测试在很大程度上依赖于XpertMTB/RIF，目前尚不清楚耐药（DR）结核病的诊断和治疗比例。
■我们对2015-2018年在印度尼西亚一家三级医院注册的推定利福平耐药（RR）结核病患者队列进行了级联护理分析。（推定）DR-TB病例的估计发病率是基于全球报告的假设。诊断和连续级联步骤的数据，包括他们的时间是从国家电子登记册收集的，和医疗记录。我们描述了接受表型药物敏感性测试（pDST）不支持治疗的患者的次级级联反应。使用逻辑回归确定与诊断和治疗之间的延迟和丢失相关的因素。
■不到三分之一的有DR-TB风险的结核病病例被确定为推定DR-TB病例并进行测试，9.8%(982/10,065)的估计真实DR-TB病例被诊断。在那些被诊断的人中，只有45.1%(443/982)的治疗方案得到pDST结果的支持，但这并未显著影响治疗结局.只有25.5％（250/982）的诊断患者完成了级联的所有步骤，包括成功的治疗。诊断和治疗之间的延迟很大，在初级医疗机构转诊的人中更常见，在那些受雇的人中，住在万隆之外,并报告与私营部门的接触。
■在印度尼西亚这个城市环境中，DR-TB护理级联的特点是大量的减员和延误。增加获得DR-TB诊断的策略，同时优化临床护理，可以大大改善结果并减少继续传播。
■Radboud大学医学中心和奥塔哥大学。
■我们对2015-2018年在印度尼西亚一家三级医院注册的推定利福平耐药（RR）结核病患者队列进行了级联护理分析。（推定）DR-TB病例的估计发病率是基于全球报告的假设。诊断和连续级联步骤的数据，包括他们的时间是从国家电子登记册收集的，和医疗记录。我们描述了接受表型药物敏感性测试（pDST）不支持治疗的患者的次级级联反应。使用逻辑回归确定与诊断和治疗之间的延迟和丢失相关的因素。
■不到三分之一的有DR-TB风险的结核病病例被确定为推定DR-TB病例并进行测试，9.8%(982/10,065)的估计真实DR-TB病例被诊断。在那些被诊断的人中，只有45.1%(443/982)的治疗方案得到pDST结果的支持，但这并未显著影响治疗结局.只有25.5％（250/982）的诊断患者完成了级联的所有步骤，包括成功的治疗。诊断和治疗之间的延迟很大，在初级医疗机构转诊的人中更常见，在那些受雇的人中，住在万隆之外,并报告与私营部门的接触。
■在印度尼西亚这个城市环境中，DR-TB护理级联的特点是大量的减员和延误。增加获得DR-TB诊断的策略，同时优化临床护理，可以大大改善结果并减少继续传播。
■Radboud大学医学中心和奥塔哥大学。
