University of North Carolina, Chapel Hill, North Carolina, USA.
Int J Tuberc Lung Dis. 2011 Nov;15(11):1540-5, i. doi: 10.5588/ijtld.10.0273.
Adherence to tuberculosis (TB) treatment is important for TB control. The effect of stigma on adherence has not been well quantified.
To identify the effects of TB and acquired immune-deficiency syndrome (AIDS) stigma on missed doses during TB treatment.
Validated TB and AIDS stigma scales assessing perceived and experienced/felt stigma were administered in a prospective cohort of 459 TB patients at TB treatment initiation and after 2 months. Repeated measures and multivariable models estimated the effects of stigma on the rate of missed doses.
Fifty-six per cent of patients missed no doses, and associations between stigma and missed doses were minimal. Heterogeneity of effects was observed, how- ever, with higher experienced and felt TB stigma increasing missed doses among women (adjusted RR 1.22, 95%CI 1.10-1.34) and human immunodeficiency virus (HIV) co-infected patients (aRR 1.39, 95%CI 1.13-1.72). Experienced and felt AIDS stigma also increased missed doses among HIV co-infected patients (aRR 1.43, 95%CI 1.31-1.56).
Stigma has a minimal effect in this population with good adherence. Among women and HIV co-infected patients, however, experienced and felt stigma, and not perceived stigma, increased the rate of missed doses. Further research is needed to determine if stigma or coping interventions among these subgroups would improve adherence.
结核病（TB）治疗的依从性对于结核病控制很重要。耻辱感对依从性的影响尚未得到很好的量化。
确定结核病和获得性免疫缺陷综合征（AIDS）耻辱感对结核病治疗期间漏服剂量的影响。
在结核病治疗开始时和 2 个月后，对 459 名结核病患者进行了前瞻性队列研究，使用经过验证的结核病和艾滋病耻辱量表评估了感知和经历/感觉耻辱。重复测量和多变量模型估计了耻辱感对漏服剂量的影响。
56%的患者没有漏服剂量，耻辱感与漏服剂量之间的关联很小。然而，观察到了效应的异质性，即较高的经历和感觉结核病耻辱感增加了女性（调整 RR 1.22，95%CI 1.10-1.34）和人类免疫缺陷病毒（HIV）合并感染患者（调整 RR 1.39，95%CI 1.13-1.72）的漏服剂量。经历和感觉艾滋病耻辱感也增加了 HIV 合并感染患者的漏服剂量（调整 RR 1.43，95%CI 1.31-1.56）。
在这个依从性良好的人群中，耻辱感的影响很小。然而，在女性和 HIV 合并感染患者中，经历和感觉耻辱感而非感知耻辱感增加了漏服剂量的发生率。需要进一步研究以确定在这些亚组中是否通过耻辱感或应对干预措施来提高依从性。
