Department of General Medicine, Medical College, Kolkata, 88 College Street, Kolkata, West Bengal 700073, India.
J Community Health. 2010 Oct;35(5):471-8. doi: 10.1007/s10900-009-9215-z.
We aimed to study the prevalence and determinants of non compliance to intensive phase anti tubercular treatment (ATT) in 111 HIV-TB coinfection patients, attending the APEX Referral Center for HIV/AIDS at Medical College, Kolkata with a specially-designed, semi-structured, pre-tested questionnaire. Compliance was defined as taking ≥95% of the total scheduled doses of anti-TB medicines during the intensive phase. Data was collected on socio-demographic parameters, disease information, patient's knowledge and barriers to treatment. The prevalence of non-compliance to ATT in HIV-TB coinfection patients was found to be 40.5% (95% C.I. = 30.5, 50.5). Multivariate logistic regression analysis showed that absence of proper counseling, lack of knowledge about correct route of TB transmission, visiting quacks during ATT and the urge to leave treatment once patient started feeling better were the significant determinants of non-compliance. "No Counseling" increased chances of non- compliance (adjusted O.R.) 47.12 times (95% C.I. = 7.99, 195.27); thereby being the single most influential variable towards the outcome. The present study finds an alarmingly high prevalence of non-compliance to ATT among HIV-TB coinfection patients. The results clearly indicate that adequate counseling about this coinfection and the importance of compliance, along with better patient-friendly orientation of DOTS programme is urgently needed. Collaborative TB-HIV activities are essential to ensure better ATT compliance in coinfection patients.
我们旨在研究 111 例 HIV-TB 合并感染患者在接受加尔各答医学院 APEX 艾滋病转诊中心治疗期间不遵守强化期抗结核治疗（ATT）的流行率和决定因素，为此我们设计了专门的、半结构化的、预测试问卷。依从性定义为在强化期内服用≥95%的总计划抗结核药物剂量。收集了社会人口统计学参数、疾病信息、患者知识和治疗障碍的数据。HIV-TB 合并感染患者不遵守 ATT 的比例为 40.5%（95%CI=30.5，50.5）。多变量逻辑回归分析表明，缺乏适当的咨询、缺乏正确的结核病传播途径的知识、在 ATT 期间看庸医以及一旦患者感觉好转就离开治疗的愿望是不遵守 ATT 的重要决定因素。“没有咨询”增加了不遵守规定的几率（调整后的 OR）47.12 倍（95%CI=7.99，195.27）；因此，这是导致这一结果的最具影响力的单一变量。本研究发现，HIV-TB 合并感染患者不遵守 ATT 的比例高得惊人。结果清楚地表明，迫切需要就这种合并感染进行充分的咨询，并强调遵守规定的重要性，同时使 DOTS 方案更有利于患者。需要开展结核病-艾滋病合作活动，以确保合并感染患者更好地遵守 ATT。
