Access to Bacteriologic-Based Diagnosis in Smear Positive Retreatment Tuberculosis Patients in Rural China: A Cross-Sectional Study in Three Geographic Varied ProvincesReportar como inadecuado




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Objective

To determine factors influencing the utilization and accessibility to bacteriologic-based tuberculosis TB diagnosis among sputum smear positive SS+ retreatment TB patients, and to develop strategies for improving the case detection rate of MDR-TB in rural China.

Study Design and Setting

A cross-sectional study of SS+ TB retreatment patients was conducted in eight counties from three provinces with different implementation period and strategy of MDR-TB program in China. Demographic and socioeconomic parameters were collected by self-reporting questionnaires. Sputum samples were collected and cultured by the laboratory of county-designated TB clinics and delivered to prefectural Centers for Disease Prevention and Control CDC labs for DST with 4 first-line anti-TB drugs.

Results

Among the 196 SS+ retreatment patients, 61.22% received culture tests during current treatment. Patients from more developed regions OR = 24.0 and 3.6, 95% CI: 8.6–67.3 and 1.1–11.6, with better socio-economic status OR = 3. 8, 95% CI: 1.3–10.7, who had multiple previous anti-TB treatments OR = 5.0, 95% CI: 1.6–15.9, and who failed in the most recent anti-TB treatment OR = 2.6, 95% CI: 1.0–6.4 were more likely to receive culture tests. The percentage of isolates resistant to any of first-line anti-TB drugs and MDR-TB were 50.0% 95% CI: 39.8%-60.2% and 30.4% 95% CI: 21.0%-39.8% respectively.

Conclusions

Retreatment SS+ TB patients, high risk MDR-TB population, had poor utilization of access to bacteriologic-based TB diagnosis, which is far from optimal. The next step of anti-TB strategy should be focused on how to make bacteriological-based diagnosis cheaper, safer and more maneuverable, and how to assure the DST-guided treatment for these high-risk TB patients.



Autor: Changming Zhou, Weili Jiang, Li Yuan, Wei Lu, Jinge He, Qi Zhao , Biao Xu

Fuente: http://plos.srce.hr/



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