Shieh Fred K, Snyder Graham, Horsburgh C Robert, Bernardo John, Murphy Claire, Saukkonen Jussi J
Pulmonary Center, Boston University School of Medicine, 80 East Concord Street, R-304, Boston, MA 02118, USA.
Am J Respir Crit Care Med. 2006 Sep 15;174(6):717-21. doi: 10.1164/rccm.200510-1667OC. Epub 2006 Jun 29.
Treatment of latent tuberculosis (TB) infection (LTBI) is essential for the elimination of TB in the United States, but treatment is often not completed. Little is known about patients' reasons for not completing treatment. We hypothesized that certain health beliefs, lifestyle, and clinic- and regimen-related barriers to provision of care could predict non-completion of LTBI treatment.
We administered a survey in English, Chinese, or Spanish to patients with LTBI at the first TB clinic visit. Using chi(2) and logistic regression analysis, we assessed demographics, TB risk factors, and survey responses as predictors of non-completion of 6 mo of isoniazid.
217 patients, 90% foreign-born, completed the survey, and 28.6% of which finished at least 6 mo of isoniazid under usual clinic conditions. Multivariate analysis identified two independent predictors of non-completion: low risk perception of progressing to active TB without LTBI treatment (odds ratio [OR], 0.31 [0.13-0.72], 95% confidence interval [CI]), p = 0.007, accounting for 20% of non-completers, and not wanting venipuncture (OR, 0.43 [0.22-0.85], 95% CI), p = 0.015, accounting for 37% of non-completers. Another 18% shared both predictors; thus these two predictors accounted for 75% of non-completers in total.
Patients assess LTBI treatment risks and inconveniences relative to low perceived benefits at treatment outset. Predictors of LTBI treatment non-completion are identifiable at the first visit. Targeting TB high-risk individuals, minimizing inconveniences, further education, and use of diagnostic tests with improved specificity for TB may address these concerns.
在美国，治疗潜伏性结核感染（LTBI）对于消除结核病至关重要，但治疗往往无法完成。对于患者未完成治疗的原因知之甚少。我们假设某些健康观念、生活方式以及与诊所和治疗方案相关的护理障碍可能会预测LTBI治疗的未完成情况。
我们在患者首次就诊于结核病诊所时，用英语、中文或西班牙语对LTBI患者进行了一项调查。使用卡方检验和逻辑回归分析，我们评估了人口统计学特征、结核病风险因素以及调查回复，将其作为未完成6个月异烟肼治疗的预测因素。
217名患者完成了调查，其中90%出生于国外，在常规诊所条件下，28.6%的患者完成了至少6个月的异烟肼治疗。多变量分析确定了两个未完成治疗的独立预测因素：认为不进行LTBI治疗进展为活动性结核病的风险较低（优势比[OR]，0.31[0.13 - 0.72]，95%置信区间[CI]），p = 0.007，占未完成治疗者的20%；以及不想接受静脉穿刺（OR，0.43[0.22 - 0.85]，95%CI），p = 0.015，占未完成治疗者的37%。另外18%的患者同时具备这两个预测因素；因此这两个预测因素总共占未完成治疗者的75%。
患者在治疗开始时会评估LTBI治疗的风险和不便之处，相对于较低的感知益处而言。LTBI治疗未完成的预测因素在首次就诊时即可识别。针对结核病高危个体、尽量减少不便之处、进一步开展教育以及使用对结核病特异性更高的诊断测试可能会解决这些问题。
