背景:结核病(TB)仍然是印度的重大公共卫生负担,为2025年设定了消除目标。主动病例发现(ACF)对于提高结核病病例检测率至关重要,尽管缺乏与治疗结果相关的确凿证据.我们的研究旨在调查ACF对古吉拉特邦肺结核患者成功结核病治疗结果的影响。印度,并探讨为什么ACF对这些结果产生积极影响。
方法:我们在古吉拉特邦进行了回顾性队列分析,印度,包括2019年1月至2020年12月通过ACF确定的1,638例肺结核病例和通过被动病例发现(PCF)确定的80,957例肺结核病例。广义逻辑混合模型比较ACF和PCF组的治疗结果。此外,我们对11名结核病项目工作人员进行了深入访谈,以探讨他们对ACF的看法及其对结核病治疗结局的影响.
结果:我们的分析显示,与通过PCF确定的患者相比,通过ACF诊断的患者显示出1.4倍的成功治疗结果。项目工作人员强调,ACF提高了病例检出率,并能够及早发现并迅速开始治疗。这种早期干预有助于更快的痰转化,并有助于减少传染期,从而改善治疗结果。功能人员强调,ACF识别出可能错过的结核病例,确保及时和适当的治疗。
结论:ACF显著改善了古吉拉特邦的结核病治疗结果,印度。混合方法分析表明ACF与成功的结核病治疗之间存在正相关,早期发现和及时开始治疗是关键因素。结核病项目工作人员的见解强调了ACF在确保及时诊断和治疗方面的重要性,这对于更好的治疗结果至关重要。扩大ACF倡议,特别是在难以到达的人群中,可以进一步加强结核病控制工作。未来的研究应集中在优化ACF策略和整合其他干预措施以维持和改善结核病治疗结果。
BACKGROUND: Tuberculosis (TB) remains a significant public health burden in
India, with elimination targets set for 2025. Active
case finding (ACF) is crucial for improving TB
case detection rates, although conclusive evidence of its association with treatment outcomes is lacking. Our study aims to investigate the impact of ACF on successful TB treatment outcomes among pulmonary TB patients in Gujarat, India, and explore why ACF positively impacts these outcomes.
METHODS: We conducted a retrospective cohort analysis in Gujarat, India, including 1,638 pulmonary TB cases identified through ACF and 80,957 cases through passive
case finding (PCF) from January 2019 to December 2020. Generalized logistic mixed-model compared treatment outcomes between the ACF and PCF groups. Additionally, in-depth interviews were conducted with 11 TB program functionaries to explore their perceptions of ACF and its impact on TB treatment outcomes.
RESULTS: Our analysis revealed that patients diagnosed through ACF exhibited 1.4 times higher odds of successful treatment outcomes compared to those identified through PCF. Program functionaries emphasized that ACF enhances
case detection rates and enables early detection and prompt treatment initiation. This early intervention facilitates faster sputum conversion and helps reduce the infectious period, thereby improving treatment outcomes. Functionaries highlighted that ACF identifies TB cases that might otherwise be missed, ensuring timely and appropriate treatment.
CONCLUSIONS: ACF significantly improves TB treatment outcomes in Gujarat,
India. The mixed-methods analysis demonstrates a positive association between ACF and successful TB treatment, with early detection and prompt treatment initiation being key factors. Insights from TB program functionaries underscore the importance of ACF in ensuring timely diagnosis and treatment, which are critical for better treatment outcomes. Expanding ACF initiatives, especially among hard-to-reach populations, can further enhance TB control efforts. Future research should focus on optimizing ACF strategies and integrating additional interventions to sustain and improve TB treatment outcomes.