Batki Steven L, Gruber Valerie A, Bradley Julia Moon, Bradley Mark, Delucchi Kevin
Department of Psychiatry, State University of New York Upstate Medical University, 750 East Adams St., Syracuse 13210, USA.
Drug Alcohol Depend. 2002 May 1;66(3):283-93. doi: 10.1016/s0376-8716(01)00208-3.
Substance abuse is associated with high risk for tuberculosis (TB) and poor adherence to medication regimens. This study compared completion rates for isoniazid (INH) preventive therapy for injection drug users (IDUs) randomly assigned to methadone treatment combined with directly observed preventive treatment (DOPT) versus those assigned to routine TB clinic referral without methadone treatment. One hundred and eleven opioid-dependent patients with latent TB were assigned to one of three 6-month treatment conditions: standard methadone treatment including substance abuse counseling combined with daily INH DOPT (n=37); minimal methadone treatment without counseling, also combined with daily INH DOPT (n=35); or routine care referral to TB clinic for monthly INH supplies without DOPT and without methadone treatment (n=39). INH completion rates were 77.1% for minimal methadone and 59.5% for standard methadone, as compared with only 13.5% for routine care (P<0.0001). Mean duration of INH treatment retention was 5.7, 5.0 and 1.6 months, respectively (P<0.0001). TB incidence at 4-year follow-up was 0 of 54 subjects who completed preventive therapy versus 2 of 57 who failed to complete. One of these two had been assigned to routine care, and the other to minimal methadone. In conclusion, INH retention time and completion rates were significantly improved by methadone treatment combined with observed INH, whether or not substance abuse counseling was provided. The results of this study indicate that methadone treatment offers clear public health benefits when it is used to deliver preventive medical services.
药物滥用与结核病（TB）的高风险以及对药物治疗方案的依从性差有关。本研究比较了随机分配接受美沙酮治疗并联合直接观察预防治疗（DOPT）的注射吸毒者（IDU）与分配到常规结核病门诊转诊且未接受美沙酮治疗的IDU接受异烟肼（INH）预防性治疗的完成率。111名潜伏性结核的阿片类药物依赖患者被分配到三种为期6个月的治疗方案之一：标准美沙酮治疗，包括药物滥用咨询并联合每日INH DOPT（n = 37）；最小剂量美沙酮治疗，无咨询，也联合每日INH DOPT（n = 35）；或常规护理转诊至结核病门诊，每月供应INH，无DOPT且无美沙酮治疗（n = 39）。最小剂量美沙酮组的INH完成率为77.1%，标准美沙酮组为59.5%，而常规护理组仅为13.5%（P<0.0001）。INH治疗持续的平均时间分别为5.7、5.0和1.6个月（P<0.0001）。在4年随访时，完成预防性治疗的54名受试者中结核病发病率为0，而未完成治疗的57名受试者中有2例发病。这两例中的一例被分配到常规护理组，另一例被分配到最小剂量美沙酮组。总之，无论是否提供药物滥用咨询，美沙酮治疗联合观察INH可显著提高INH的保留时间和完成率。本研究结果表明，美沙酮治疗用于提供预防性医疗服务时具有明显的公共卫生益处。
