RESUMO
BACKGROUND: Australia has a low incidence of TB and has committed to eliminating the disease. Identification of risk factors associated with TB is critical to achieving this goal.METHODS: We undertook a prospective cohort study involving persons receiving TB treatment in four Australian jurisdictions. Risk factors and their association with delayed treatment completion (treatment delayed by at least 1 month) were analysed using univariate analyses and multivariate logistic regression.RESULTS: Baseline surveys were completed for 402 persons with TB. Most (86.1%) were born overseas. Exposure to a person with TB was reported by 19.4%. Diabetes mellitus (10.2%), homelessness (9.2%), cigarette smoking (8.7%), excess alcohol consumption (6.0%) and mental illness (6.2%) were other common risk factors. At follow-up, 24.8% of patients had delayed treatment completion, which was associated with adverse events (34.1%, aOR 6.67, 95% CI 3.36-13.27), excess alcohol consumption (6.0%, aOR 21.94, 95% CI 6.03-79.85) and HIV co-infection (2.7%, aOR 8.10, 95% CI 1.16-56.60).CONCLUSIONS: We identified risk factors for TB and their association with delayed treatment completion, not all of which are routinely collected for surveillance purposes. Recognition of these risk factors should facilitate patient-centred care and assist Australia in reaching TB elimination.
Assuntos
Infecções por HIV , Tuberculose , Austrália/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Estudos Prospectivos , Fatores de Risco , Tempo para o Tratamento , Tuberculose/complicações , Tuberculose/epidemiologiaRESUMO
Education and counselling for people with drug-resistant tuberculosis (DR-TB) is recommended by the World Health Organization, given the arduous treatment journey. A model of education and counselling involving counsellors and peer counsellors, standard sessions and novel education tools was piloted in the high DR-TB burden context of Daru, Papua New Guinea. The pilot contributed to high retention in care, highlighting the need for investment in scalable models. Future models will need to be adapted as better tolerated regimens are introduced. A focus on patient-centred care requires prioritisation in order to meet the End TB Strategy targets.
L'éducation et le conseil aux personnes atteintes de tuberculose pharmacorésistante (DR-TB) sont recommandés par l'Organisation Mondiale de la Santé, étant donné les difficultés du parcours thérapeutique. Un modèle d'éducation et de conseil impliquant des conseillers et des pairs éducateurs, des sessions standard et de nouveaux outils d'éducation a été expérimenté dans le contexte de taux élevé de DR-TB de Daru en Papouasie Nouvelle Guinée. Ce projet pilote a contribué à un taux élevé de maintien en soins et a mis en lumière le besoin d'investir dans des modèles évolutifs. Les modèles futurs devront s'adapter aux protocoles mieux tolérés qui seront introduits. Une concentration sur les soins centrés sur le patient requiert une priorisation afin d'atteindre les objectifs de la stratégie Mettre fin à la TB.
La Organización Mundial de la Salud recomienda actividades de educación y orientación dirigidas a las personas con diagnóstico de tuberculosis farmacorresistente (DR-TB), habida cuenta de la trayectoria ardua del tratamiento. En el contexto de Daru, donde la carga de morbilidad por DR-TB es alta, se ensayó un modelo de educación y orientación. El proyecto piloto comportó la participación de consejeros, la orientación entre pares, sesiones ordinarias y nuevas herramientas pedagógicas. El proyecto contribuyó a lograr una alta retención en el servicio de atención y destacó la necesidad de inversión en modelos que se puedan ampliar. Será necesario adaptar los modelos futuros a medida que se introduzcan esquemas terapéuticos mejor tolerados. Un enfoque centrado en el paciente exige la definición de prioridades con miras a cumplir las metas de la Estrategia Fin a la Tuberculosis.
