Upholding Tuberculosis Services during the 2014 Ebola Storm: An Encouraging Experience from Conakry, Guinea

SettingTen targeted health facilities supported by Damien Foundation (a Belgian Non Governmental Organization) and the National Tuberculosis (TB) Program in Conakry, Guinea.ObjectivesTo uphold TB program performance during the Ebola outbreak in the presence of a package of pre-emptive additional measures geared at reinforcing the routine TB program, and ensuring Ebola infection control, health-workers safety and motivation.DesignA retrospective comparative cohort study of a TB program assessing the performance before (2013) and during the (2014) Ebola outbreak.ResultsDuring the Ebola outbreak, all health facilities were maintained opened, there were no reported health-worker Ebola infections, drug stockouts or health staff absences.Of 2,475 presumptive pulmonary TB cases, 13% were diagnosed with TB in both periods (160/1203 in 2013 and 163/1272 in 2014). For new TB, treatment success improved from 84% before to 87% during the Ebola outbreak (P = 0.03). Adjusted Hazard-ratios (AHR) for an unfavorable outcome was alwo lower during the Ebola outbreak, AHR = 0.8, 95% CI:0.7–0.9, P = 0.04). Treatment success improved for HIV co-infected patients (72% to 80%, P.01). For retreatment patients, the proportion achieving treatment success was maintained (68% to 72%, P = 0.05). Uptake of HIV-testing and Cotrimoxazole Preventive Treatment was maintained over 85%, and Anti-Retroviral Therapy uptake increased from 77% in 2013 to 86% in 2014 (P0.01).ConclusionContingency planning and health system and worker support during the 2014 Ebola outbreak was associated with encouraging and sustained TB program performance. This is of relevance to future outbreaks.

研究场景：十家定点医疗机构，均由比利时非政府组织达米恩基金会（Damien Foundation）与几内亚科纳克里地区国家结核病（Tuberculosis, TB）项目支持。研究目标：在埃博拉（Ebola）疫情暴发期间，通过一系列预防性附加措施强化常规结核病防控工作，落实埃博拉感染防控要求，保障医护人员安全与工作积极性，以维持结核病项目的运行绩效。研究设计：本研究为回顾性比较队列研究，针对结核病项目，对比埃博拉疫情暴发前（2013年）与暴发期间（2014年）的项目运行绩效。研究结果：埃博拉疫情暴发期间，所有定点医疗机构均保持开放，未报告医护人员埃博拉感染、药品缺货或医护人员缺勤事件。在总计2475例疑似肺结核病例中，两个研究时期的结核病确诊率均为13%：2013年为160/1203，2014年为163/1272。新发结核病患者的治疗成功率从疫情前的84%提升至疫情期间的87%（P=0.03）。埃博拉疫情期间，不良治疗结局的校正风险比（Adjusted Hazard Ratio, AHR）也更低，为0.8（95%置信区间：0.7~0.9，P=0.04）。合并人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）感染患者的治疗成功率从72%提升至80%（P<0.01）。复治结核病患者的治疗成功率维持稳定（从68%升至72%，P=0.05）。HIV检测与复方新诺明预防性治疗（Cotrimoxazole Preventive Treatment）的开展率均维持在85%以上，抗反转录病毒治疗（Anti-Retroviral Therapy, ART）的开展率从2013年的77%提升至2014年的86%（P<0.01）。研究结论：2014年埃博拉疫情期间实施的应急预案、医疗系统保障与医护人员支持措施，可使结核病项目的运行绩效保持良好且可持续，该研究结果对未来突发公共卫生事件的应对具有重要参考价值。