PDF(Pubmed)
Abstract：
UNASSIGNED: In a cluster randomized trial (clinicaltrials.gov: NCT02810678) a flexible but comprehensive health system intervention significantly increased the number of household contacts (HHC) identified and started on tuberculosis preventive treatment (TPT). A follow-up study was conducted one year later to test the hypotheses that these effects were sustained, and were reproducible with a simplified intervention.
UNASSIGNED: We conducted a follow-up study from May 1, 2018 until April 30, 2019, as part of a multinational cluster randomized trial. Eight sites in 4 countries that had received the intervention in the original trial received no further intervention; eight other sites in the same countries that had not received the intervention (control sites in the original trial) now received a simplified version of the intervention. This consisted of repeated local evaluation of the Cascade of care for TB infection, and stakeholder decision making. The number of HHC identified and starting TPT were repeatedly measured at all 16 sites and expressed as rates per 100 newly diagnosed index TB patients. The sustained effect of the original intervention was estimated by comparing these rates after the intervention in the original trial with the last 6 months of the follow-up study. The reproducibility was estimated by comparing the pre-post intervention changes in rates at sites receiving the original intervention with the pre-post changes in rates at sites receiving the later, simplified intervention.
UNASSIGNED: With regard to the sustained impact of the original intervention, compared to the original post-intervention period, the number of HHC identified and treated per 100 newly diagnosed TB patients was 10 more (95% confidence interval: 84 fewer to 105 more), and 1 fewer (95% CI: 22 fewer to 20 more) respectively up to 14 months after the end of the original intervention. With regard to the reproducibility of the simplified intervention, at sites that had initially served as control sites, the number of HHC identified and treated per 100 TB patients increased by 33 (95% CI: -32, 97), and 16 (-69, 100) from 3 months before, to up to 6 months after receiving a streamlined intervention, although differences were larger, and significant if the post-intervention results were compared to all pre-intervention periods.
UNASSIGNED: Up to one year after it ended, a health system intervention resulted in sustained increases in the number of HHC identified and starting TPT. A simplified version of the intervention was associated with non-significant increases in the identification and treatment of HHC. Inferences are limited by potential bias due to other temporal effects, and the small number of study sites.
UNASSIGNED: Funded by the Canadian Institutes of Health Research (Grant number 143350).
UNASSIGNED: We conducted a follow-up study from May 1, 2018 until April 30, 2019, as part of a multinational cluster randomized trial. Eight sites in 4 countries that had received the intervention in the original trial received no further intervention; eight other sites in the same countries that had not received the intervention (control sites in the original trial) now received a simplified version of the intervention. This consisted of repeated local evaluation of the Cascade of care for TB infection, and stakeholder decision making. The number of HHC identified and starting TPT were repeatedly measured at all 16 sites and expressed as rates per 100 newly diagnosed index TB patients. The sustained effect of the original intervention was estimated by comparing these rates after the intervention in the original trial with the last 6 months of the follow-up study. The reproducibility was estimated by comparing the pre-post intervention changes in rates at sites receiving the original intervention with the pre-post changes in rates at sites receiving the later, simplified intervention.
UNASSIGNED: With regard to the sustained impact of the original intervention, compared to the original post-intervention period, the number of HHC identified and treated per 100 newly diagnosed TB patients was 10 more (95% confidence interval: 84 fewer to 105 more), and 1 fewer (95% CI: 22 fewer to 20 more) respectively up to 14 months after the end of the original intervention. With regard to the reproducibility of the simplified intervention, at sites that had initially served as control sites, the number of HHC identified and treated per 100 TB patients increased by 33 (95% CI: -32, 97), and 16 (-69, 100) from 3 months before, to up to 6 months after receiving a streamlined intervention, although differences were larger, and significant if the post-intervention results were compared to all pre-intervention periods.
UNASSIGNED: Up to one year after it ended, a health system intervention resulted in sustained increases in the number of HHC identified and starting TPT. A simplified version of the intervention was associated with non-significant increases in the identification and treatment of HHC. Inferences are limited by potential bias due to other temporal effects, and the small number of study sites.
UNASSIGNED: Funded by the Canadian Institutes of Health Research (Grant number 143350).
摘要：
■在一项整群随机试验（clinicaltrials.gov：NCT02810678）中，灵活而全面的卫生系统干预措施显着增加了确定并开始进行结核病预防治疗（TPT）的家庭接触者（HHC）的数量。一年后进行了一项后续研究，以检验这些影响持续的假设，并且在简化的干预下具有可重复性。
■我们从2018年5月1日至2019年4月30日进行了一项随访研究，作为一项多国整群随机试验的一部分。在原始试验中接受干预的4个国家的8个站点未接受进一步干预；在同一国家未接受干预的其他8个站点（原始试验中的对照站点）现在接受了简化版本的干预。这包括对结核病感染的级联护理的反复局部评估，和利益相关者决策。在所有16个部位重复测量HHC识别和起始TPT的数量，并表示为每100名新诊断的指标TB患者的比率。通过比较原始试验中干预后与随访研究的最后6个月的这些比率来评估原始干预的持续效果。通过比较接受原始干预的地点的干预前干预后比率变化与接受后干预的地点的干预前比率变化来估计再现性。简化干预。
■关于原始干预措施的持续影响，与最初的干预后时期相比，每100名新诊断的结核病患者中已识别和治疗的HHC数量增加了10个（95％置信区间：减少84到105个），在原始干预结束后的14个月内，分别减少1个（95％CI：减少22至增加20个）。关于简化干预的可重复性，在最初作为控制地点的地点，每100例结核病患者中确定和治疗的HHC数量增加了33例(95%CI：-32，97)，和3个月前的16（-69，100），在接受简化的干预后长达6个月，尽管差异更大，如果将干预后结果与所有干预前时期进行比较，则具有重要意义。
■在它结束一年后，卫生系统干预导致已识别和开始TPT的HHC数量持续增加。干预的简化版本与HHC的识别和治疗的非显著增加相关。由于其他时间效应，推论受到潜在偏差的限制，和少量的研究地点。
■由加拿大卫生研究院资助（资助号143350）。
■我们从2018年5月1日至2019年4月30日进行了一项随访研究，作为一项多国整群随机试验的一部分。在原始试验中接受干预的4个国家的8个站点未接受进一步干预；在同一国家未接受干预的其他8个站点（原始试验中的对照站点）现在接受了简化版本的干预。这包括对结核病感染的级联护理的反复局部评估，和利益相关者决策。在所有16个部位重复测量HHC识别和起始TPT的数量，并表示为每100名新诊断的指标TB患者的比率。通过比较原始试验中干预后与随访研究的最后6个月的这些比率来评估原始干预的持续效果。通过比较接受原始干预的地点的干预前干预后比率变化与接受后干预的地点的干预前比率变化来估计再现性。简化干预。
■关于原始干预措施的持续影响，与最初的干预后时期相比，每100名新诊断的结核病患者中已识别和治疗的HHC数量增加了10个（95％置信区间：减少84到105个），在原始干预结束后的14个月内，分别减少1个（95％CI：减少22至增加20个）。关于简化干预的可重复性，在最初作为控制地点的地点，每100例结核病患者中确定和治疗的HHC数量增加了33例(95%CI：-32，97)，和3个月前的16（-69，100），在接受简化的干预后长达6个月，尽管差异更大，如果将干预后结果与所有干预前时期进行比较，则具有重要意义。
■在它结束一年后，卫生系统干预导致已识别和开始TPT的HHC数量持续增加。干预的简化版本与HHC的识别和治疗的非显著增加相关。由于其他时间效应，推论受到潜在偏差的限制，和少量的研究地点。
■由加拿大卫生研究院资助（资助号143350）。
