Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
Scand J Public Health. 2009 May;37(3):304-9. doi: 10.1177/1403494809103907. Epub 2009 Mar 13.
To analyse the current status of directly observed therapy (DOT) and completion of treatment of tuberculosis (TB) in two rural areas of China.
Two rural counties with low DOT rates were deliberately selected as study sites. Face-to-face interviews were conducted by trained investigators with a structured questionnaire to investigate the characteristics of patients and the TB service that they had received. The associations between treatment completion and potential factors were estimated by computing odds ratios (ORs), as well as their 95% confidence intervals (CIs), from an unconditional logistic regression model.
Among 601 patients, 2.2% were treated with direct observation by health workers, 6.2% were supervised by family members, and 91.7% were treated with self-administered therapy. The treatment completion rate was found to be significantly associated with sputum smear test and adverse reaction to anti-tuberculosis drugs, but not with direct observation by health workers (OR 1.81, 95% CI 0.23-14.38) or by family members (OR 1.14, 95% CI 0.38-3.41). Frequent home visiting by health workers (!1 visit/month) could help to increase the completion rate (OR 3.15, 95% CI 1.30-7.63).
No significant difference was found in the rate of completion of TB treatment between direct observation and self-supervision groups in two rural areas with lower DOT coverage. How to build a feasible DOT strategy that is accepted by both patients and healthcare providers needs to be considered by policy-makers. Other elements apart from DOT are necessary to ensure a successful TB programme.
分析中国两个农村地区结核病直接督导治疗（DOT）现状及治疗完成情况。
特意选取两个DOT率较低的农村县作为研究地点。由经过培训的调查人员使用结构化问卷进行面对面访谈，以调查患者特征及其接受的结核病服务情况。通过无条件逻辑回归模型计算比值比（OR）及其95%置信区间（CI），估计治疗完成情况与潜在因素之间的关联。
在601例患者中，2.2%接受卫生工作者直接督导治疗，6.2%由家庭成员监督，91.7%接受自我给药治疗。发现治疗完成率与痰涂片检查及抗结核药物不良反应显著相关，但与卫生工作者直接督导（OR 1.81，95%CI 0.23 - 14.38）或家庭成员督导（OR 1.14，95%CI 0.38 - 3.41）无关。卫生工作者频繁家访（每月≥1次）有助于提高完成率（OR 3.15，95%CI 1.30 - 7.63）。
在两个DOT覆盖率较低的农村地区，直接督导组与自我监督组的结核病治疗完成率无显著差异。政策制定者需考虑如何制定一个患者和医疗服务提供者都能接受的可行的DOT策略。除DOT外，其他因素对于确保结核病防治项目的成功也很必要。
