Cáceres Flor de María, Orozco Luis Carlos
Departamento de Salud Pública, Escuela de Medicina, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia.
Biomedica. 2007 Dec;27(4):498-504.
Tuberculosis is a public health problem. Non-compliance with treatment regimes increases morbidity-mortality, perpetuates transmission and generates bacterial resistance. It is necessary to know incidence and associated factors to non-compliance for performance interventions.
The incidence of and associated factors associated with non-compliance to antituberculous treatment were investigated.
A follow-up study was conducted in an adult cohort with tuberculosis, living in an urban area. Non-compliance was defined as treatment default of 30 days or more. Patients were interviewed at the initiation of treatment and and re-interviewed in subsequent intervals. Outcome was defined as the period of time until treatment abandonment. Non-compliance rates were calculated, as well as survival curves; the Cox regression model was used to adjust for associated variables.
Of the 261 patients who were interviewed, 39 (14.9%) had abandoned treatment (rate 0.4 episodes/1,000 days-person, 95%CI 0.2-0.8). Factors associated with compliance were family support (HR=0.4, 95%CI 0.2-0.9), secondary drug effects (HR=0.2, 95%CI 0.1-0.6) and opportunity to receive treatment at the clinic where tuberculosis was diagnosed (HR=0.3, 95%CI 0.1-0.6). Risk factors for non-compliance were as follows: treatment requiring >2 months (HR=14.3, 95%CI 1.8-112.7), low socioeconomic status (HR=3.90, 95%CI 2.1-9.3), age between 21-30 years (HR=20.6, 95%CI 2.4-175.4), history of incarceration (HR=2.2, 95%CI 1.0-5.4), skipping treatments more that twice (HR=6.6, 95%CI 2.8-15.6) and co-infection with HIV/AIDS (HR=2.9, 95%CI 1.6-5.4).
Non-compliance rate is higher than previously reported. The data recommend the following strategies for improving compliance with antituberculosis treatment: (1) early diagnosis, (2) opportune treatment, (3) improved family support and (4) immediate intervention if a treatment is missed -especially in patients with HIV/AIDS, from low socioeconomic strata, or with record of incarceration.
结核病是一个公共卫生问题。不遵守治疗方案会增加发病率和死亡率，使传播持续存在并产生细菌耐药性。了解不遵守治疗方案的发生率及其相关因素对于实施干预措施很有必要。
调查抗结核治疗不遵守情况的发生率及其相关因素。
对居住在城市地区的成年结核病队列进行了一项随访研究。不遵守治疗方案被定义为治疗中断30天或更长时间。在治疗开始时对患者进行访谈，并在随后的时间段内再次访谈。结局定义为直到治疗放弃的时间段。计算不遵守治疗方案的发生率以及生存曲线；使用Cox回归模型对相关变量进行调整。
在接受访谈的261名患者中，39名（14.9%）放弃了治疗（发生率为0.4例/1000人日，95%置信区间为0.2 - 0.8）。与遵守治疗方案相关的因素包括家庭支持（风险比=0.4，95%置信区间为0.2 - 0.9）、药物的次要副作用（风险比=0.2，95%置信区间为0.1 - 0.6）以及在结核病诊断诊所接受治疗的机会（风险比=0.3，95%置信区间为0.1 - 0.6）。不遵守治疗方案的风险因素如下：治疗需要超过2个月（风险比=14.3，95%置信区间为1.8 - 112.7）、社会经济地位低（风险比=3.90，95%置信区间为2.1 - 9.3）、年龄在21 - 30岁之间（风险比=20.6，95%置信区间为2.4 - 175.4）、有监禁史（风险比=2.2，95%置信区间为1.0 - 5.4）、漏服治疗药物超过两次（风险比=6.6，95%置信区间为2.8 - 15.6）以及合并感染艾滋病毒/艾滋病（风险比=2.9，95%置信区间为1.6 - 5.4）。
不遵守治疗方案的发生率高于先前报告的水平。这些数据推荐以下改善抗结核治疗依从性的策略：（1）早期诊断，（2）及时治疗，（3）改善家庭支持，（4）如果漏服治疗药物应立即进行干预——尤其是对于艾滋病毒/艾滋病患者、社会经济地位低的患者或有监禁记录的患者。
