通过教育和淋巴水肿管理项目提高印度淋巴丝虫病大规模药物治疗方案的依从性。
Increasing compliance with mass drug administration programs for lymphatic filariasis in India through education and lymphedema management programs.
机构信息
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
出版信息
PLoS Negl Trop Dis. 2010 Jun 29;4(6):e728. doi: 10.1371/journal.pntd.0000728.
BACKGROUND
Nearly 45% of people living at risk for lymphatic filariasis (LF) worldwide live in India. India has faced challenges obtaining the needed levels of compliance with its mass drug administration (MDA) program to interrupt LF transmission, which utilizes diethylcarbamazine (DEC) or DEC plus albendazole. Previously identified predictors of and barriers to compliance with the MDA program were used to refine a pre-MDA educational campaign. The objectives of this study were to assess the impact of these refinements and of a lymphedema morbidity management program on MDA compliance.
METHODS/PRINCIPAL FINDINGS: A randomized, 30-cluster survey was performed in each of 3 areas: the community-based pre-MDA education plus community-based lymphedema management education (Com-MDA+LM) area, the community-based pre-MDA education (Com-MDA) area, and the Indian standard pre-MDA education (MDA-only) area. Compliance with the MDA program was 90.2% in Com-MDA+LM, 75.0% in Com-MDA, and 52.9% in the MDA-only areas (p<0.0001). Identified barriers to adherence included: 1) fear of side effects and 2) lack of recognition of one's personal benefit from adherence. Multivariable predictors of adherence amenable to educational intervention were: 1) knowing about the MDA in advance of its occurrence, 2) knowing everyone is at risk for LF, 3) knowing that the MDA was for LF, and 4) knowing at least one component of the lymphedema management techniques taught in the lymphedema management program.
CONCLUSIONS/SIGNIFICANCE: This study confirmed previously identified predictors of and barriers to compliance with India's MDA program for LF. More importantly, it showed that targeting these predictors and barriers in a timely and clear pre-MDA educational campaign can increase compliance with MDA programs, and it demonstrated, for the first time, that lymphedema management programs may also increase compliance with MDA programs.
背景
全球近 45%的淋巴丝虫病（LF）高危人群生活在印度。印度在获得足够水平的依从性方面面临挑战，其大规模药物治疗（MDA）方案旨在阻断 LF 传播，该方案利用乙胺嗪（DEC）或 DEC 加阿苯达唑。先前确定的 MDA 方案依从性的预测因素和障碍被用于改进 MDA 前的教育活动。本研究的目的是评估这些改进以及淋巴水肿发病率管理方案对 MDA 依从性的影响。
方法/主要发现：在 3 个地区（社区为基础的 MDA 前教育加社区淋巴水肿管理教育（Com-MDA+LM）区、社区为基础的 MDA 前教育（Com-MDA）区和印度标准 MDA 前教育（MDA 单药）区），每个地区都进行了一项随机、30 个集群的调查。MDA 方案的依从率在 Com-MDA+LM 区为 90.2%，Com-MDA 区为 75.0%，MDA 单药区为 52.9%（p<0.0001）。依从性的障碍包括：1）担心副作用，2）没有认识到坚持治疗对个人的好处。可通过教育干预进行调整的依从性的多变量预测因素包括：1）提前了解 MDA 的情况，2）了解每个人都有 LF 的风险，3）知道 MDA 是针对 LF 的，4）至少了解淋巴水肿管理方案中所教授的淋巴水肿管理技术的一个组成部分。
结论/意义：本研究证实了之前确定的印度 LF MDA 方案依从性的预测因素和障碍。更重要的是，它表明在及时、明确的 MDA 前教育活动中针对这些预测因素和障碍，可提高 MDA 方案的依从性，并且首次表明淋巴水肿管理方案也可能提高 MDA 方案的依从性。
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