Frontiers in public health · 2026
Severe pre-treatment attrition in the care cascade: clinical outcomes and risk factors among older MDR/RR-TB patients in China.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zhou Fangjing, Huang Shanshan, Feng Huiying, Li Jianwei, Wu Huizhong, Chen Yuhui, Wen Wenpei, Liu Lebin
Аннотация
BACKGROUND: The rising global burden of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) coincides with rapid population aging. Older patients face unique challenges, yet age-stratified analyses of the MDR/RR-TB care cascade are lacking, obscuring the specific barriers they encounter.
OBJECTIVE: This study aimed to characterize the treatment cascade and identify factors associated with attrition among older MDR/RR-TB patients in China.
METHODS: We conducted a retrospective cohort study of 667 MDR/RR-TB patients aged ≥65 years in Guangdong Province, southern China (2010-2022). Using data from the national Tuberculosis Information Management System (TIMS), we constructed a care cascade to quantify attrition across four stages (diagnosis, treatment initiation, retention at 6 months, and treatment success) and three inter-stage gaps (attrition between successive stages). Separate multivariable logistic regression models identified factors associated with failure to initiate treatment and with poor outcomes.
RESULTS: Of the 667 diagnosed patients (median age 70), 500 (74.96%) initiated treatment, 406 (60.87% of diagnosed cases, 81.2% of treated cases) were retained at 6 months, and only 268 (40.18% of diagnosed cases, 53.6% of treated cases) achieved treatment success. Multivariable analysis showed that workers/farmers (aOR = 1.87, 95% CI: 1.24-2.84), diagnosis by conventional DST (aOR = 9.34, 95% CI: 4.52-21.64), diagnosis before 2016 (aOR = 1.91, 95% CI: 1.18-3.08), and older age (aOR = 1.05 per year, 95% CI: 1.01-1.08) were independently associated with failure to initiate treatment; prior TB treatment history was protective (aOR = 0.42, 95% CI: 0.25-0.72). Among treatment initiators, older age (aOR = 1.06 per year, 95% CI: 1.02-1.09) and diagnosis before 2016 (aOR = 1.88, 95% CI: 1.06-3.39) were independent risk factors for poor outcomes.
CONCLUSION: The MDR/RR-TB care cascade for older patients in China is marked by severe pre-treatment attrition. Targeted interventions, including scaling up rapid molecular testing, providing targeted support (e.g., financial subsidies, home-based care, and flexible treatment schedules) for high-risk workers, and implementing geriatric-adapted follow-up, and expanding active case finding, are urgently needed to protect this vulnerable population and to close this equity gap.
OBJECTIVE: This study aimed to characterize the treatment cascade and identify factors associated with attrition among older MDR/RR-TB patients in China.
METHODS: We conducted a retrospective cohort study of 667 MDR/RR-TB patients aged ≥65 years in Guangdong Province, southern China (2010-2022). Using data from the national Tuberculosis Information Management System (TIMS), we constructed a care cascade to quantify attrition across four stages (diagnosis, treatment initiation, retention at 6 months, and treatment success) and three inter-stage gaps (attrition between successive stages). Separate multivariable logistic regression models identified factors associated with failure to initiate treatment and with poor outcomes.
RESULTS: Of the 667 diagnosed patients (median age 70), 500 (74.96%) initiated treatment, 406 (60.87% of diagnosed cases, 81.2% of treated cases) were retained at 6 months, and only 268 (40.18% of diagnosed cases, 53.6% of treated cases) achieved treatment success. Multivariable analysis showed that workers/farmers (aOR = 1.87, 95% CI: 1.24-2.84), diagnosis by conventional DST (aOR = 9.34, 95% CI: 4.52-21.64), diagnosis before 2016 (aOR = 1.91, 95% CI: 1.18-3.08), and older age (aOR = 1.05 per year, 95% CI: 1.01-1.08) were independently associated with failure to initiate treatment; prior TB treatment history was protective (aOR = 0.42, 95% CI: 0.25-0.72). Among treatment initiators, older age (aOR = 1.06 per year, 95% CI: 1.02-1.09) and diagnosis before 2016 (aOR = 1.88, 95% CI: 1.06-3.39) were independent risk factors for poor outcomes.
CONCLUSION: The MDR/RR-TB care cascade for older patients in China is marked by severe pre-treatment attrition. Targeted interventions, including scaling up rapid molecular testing, providing targeted support (e.g., financial subsidies, home-based care, and flexible treatment schedules) for high-risk workers, and implementing geriatric-adapted follow-up, and expanding active case finding, are urgently needed to protect this vulnerable population and to close this equity gap.