Finnie Ramona K C, Mabunda Tiyane, Khoza Lunic Base, van den Borne Bart, Selwyn Beatrice, Mullen Patricia Dolan
School of Public Health, University of Texas, Houston, USA.
Int Q Community Health Educ. 2010;31(1):3-19. doi: 10.2190/IQ.31.1.b.
Studies of factors influencing tuberculosis (TB) care-seeking and treatment adherence in high TB/HIV co-burden African countries have typically surveyed urban patients' sociodemographic characteristics. To understand community perceptions and guide rapid assessment interviews, we interviewed key informants (nurses, tribal leaders, n = 9) and local researchers (n = 3) in poor, rural areas of South Africa. HIV-related stigma and misperceptions about TB causes and symptoms were cited as barriers. Key informants said older people preferred traditional healers; local researchers heard a preference for "western" care and suggested supporting clinic staff travel to remote villages with health education and diagnostic services. Key informants said not understanding the consequences of incomplete treatment and reluctance to relinquish disability grants decreased adherence. All reported that nonfamily DOTS supporters provided invaluable support. Rapid assessment should include drop-outs, re-treated, and co-infected patients and ask questions examining origins of misperceptions, stigma of testing, and pre-test messages to improve community perceptions about TB care-seeking and treatment adherence.
在结核病/艾滋病双重负担较重的非洲国家，有关影响结核病就医和治疗依从性因素的研究通常调查的是城市患者的社会人口学特征。为了解社区认知并指导快速评估访谈，我们在南非贫困农村地区采访了关键信息提供者（护士、部落首领，共9人）和当地研究人员（3人）。与艾滋病相关的耻辱感以及对结核病病因和症状的误解被视为障碍。关键信息提供者表示，老年人更喜欢传统治疗师；当地研究人员则听说人们更倾向于“西医”治疗，并建议支持诊所工作人员前往偏远村庄提供健康教育和诊断服务。关键信息提供者称，不了解不完全治疗的后果以及不愿放弃残疾补助金会降低治疗依从性。所有人都报告说，非家庭直接观察治疗（DOTS）支持者提供了非常宝贵的支持。快速评估应纳入失访患者、复治患者和合并感染患者，并提出一些问题，以探究误解的根源、检测的耻辱感以及检测前的信息，从而改善社区对结核病就医和治疗依从性的认知。
