Background

The treatment success rate of pulmonary tuberculosis (PTB) patients aged 64 years and below in Japan, a tuberculosis (TB) middle-burden country with a notification of 13.9 per 100,000 populations in 2016, has been fluctuating around 70% for some years. In order to improve treatment outcome, it is critical to address those lost to follow-up (LTFU). The objective of the study therefore was to describe the characteristics of, and analyze the risk factors for those LTFU among pulmonary TB patients aged between 15 and 64, and discuss policy implications.

Methods

The study used a mixed method of quantitative and qualitative approach, and was conducted in two phases. The first involved analysis of cohort data from the national TB surveillance of PTB patients newly notified between 1 January 2006 and 31 December 2015. The second phase involved focus group (FGD) discussions with public health nurses, who are responsible for supporting TB patients’ adherence to medication, on the possible reasons why some patients become lost to follow-up.

Results

Analysis of the surveillance data suggested that among all patients, positive sputum smear (adjusted odds ratio, [aOR] 0.52, 95% confidence interval [CI] 0.47–0.58) and cavitary lesion on chest x-ray (aOR 0.79, 95%CI 0.72–0.85) decreased the risk, while not requiring hospitalization increased the risk of LTFU (aOR 1.46, 95%CI 1.33–1.60). Among females, being a physician (aOR 2.07 95%CI 1.23–3.48) and nurse (aOR 1.18, 95%CI 1.91–1.37) were identified as additional risk factors for LTFU. The analysis of focus group discussions revealed three possible themes which may be useful in understanding why nurses and physicians were at a higher risk of becoming LTFU–firstly, the possibility that physicians and nurses were finding it difficult to make medication taking a routine, secondly, their low risk perception towards TB is affecting their adherence behavior, and thirdly, their unwillingness to accept DOTS was increasing their risk of becoming LTFU.

Conclusions

The analysis of surveillance data and FGD transcripts indicated that patient education for those starting their treatment as an outpatient, and establishing DOTS that is both acceptable and realistic to physicians and nurses, may be two issues which need to be addressed urgently.

中文翻译：

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在日本，定量和定性相结合的方法调查了因结核病治疗而丢失的风险因素–医生和护士是否处于特殊风险中？

背景

在日本这个结核病（TB）中等负担国家，64岁及以下的肺结核（PTB）患者的治疗成功率在2016年一直在70％左右波动，日本是结核病（TB）的中等负担国家，在2016年每10万人中有13.9人患病。为了改善治疗效果，至关重要的是应对那些因随访而丢失的患者（LTFU）。因此，本研究的目的是描述年龄在15至64岁之间的肺结核患者中LTFU的特征，并分析其风险因素，并讨论政策含义。

方法

该研究使用了定量和定性的混合方法，并分两个阶段进行。第一阶段涉及对2006年1月1日至2015年12月31日之间新通报的PTB患者进行全国结核病监测的队列数据分析。第二阶段涉及与负责支持结核病患者依从性的公共卫生护士进行的焦点小组（FGD）讨论。服用药物，可能会导致一些患者失去随访的可能原因。

结果

对监测数据的分析表明，在所有患者中，痰涂片阳性（校正比值比，[aOR] 0.52，95％置信区间[CI] 0.47-0.58）和胸部X光检查上的空洞病变（aOR 0.79，95％CI 0.72-0.85）降低了风险，而无需住院则增加了LTFU的风险（aOR 1.46，95％CI 1.33-1.60）。在女性中，被诊断为LTFU的其他危险因素是医生（aOR 2.07 95％CI 1.23–3.48）和护士（aOR 1.18，95％CI 1.91–1.37）。对焦点小组讨论的分析揭示了三个可能的主题，这可能有助于理解为什么护士和医师更容易成为LTFU的风险–首先，医师和护士发现难以常规服用药物的可能性，其次，

结论

对监测数据和FGD转录本的分析表明，对那些以门诊病人开始治疗并建立起医生和护士都可以接受和切合实际的DOTS的患者教育可能是两个亟待解决的问题。