Harvard Medical School, Brigham and Women’s Hospital, Division of Global Health Equity, 75 Francis Street, Boston, MA 02115, USA.
Addiction. 2013 Aug;108(8):1387-96. doi: 10.1111/add.12148. Epub 2013 May 13.
To test the feasibility and effectiveness of brief counseling intervention (BCI) and naltrexone integrated into tuberculosis (TB) care in Tomsk, Russia.
Using a factorial randomized controlled trial design, patients were randomized into: naltrexone (NTX), brief behavioral compliance enhancement therapy (BBCET), treatment as usual (TAU) and BCI.
In the Tomsk Oblast, hospitalized TB patients diagnosed with alcohol use disorders (AUDs) by the DSM-IV were referred at the start of TB treatment. Of the 196 participants, the mean age was 41 years and 82% were male. Severe TB (84.7% had cavitary disease) and smoking (92.9%) were common. The majority had a diagnosis of an AUD (63.0%); 27.6% reported nearly daily drinking and consumed a median of 16 standard drinks per day.
Primary outcomes were 'favorable' TB outcome (cured, completed treatment) and change in mean number of abstinent days in the last month of study compared with baseline. Change in mean number of heavy drinking days, defined as four drinks per day and five drinks per day for women and men, respectively, and TB adherence, measured as percentage of doses taken as prescribed under direct observation, were secondary outcomes. Analysis based on 'intention-to-treat' was performed for multivariable analysis.
Primary TB and alcohol end-points between naltrexone and no-naltrexone or BCI and no-BCI groups did not differ significantly. TB treatment adherence and change in number of heavy drinking days also did not differ significantly among treatment arms. Among individuals with a prior quitting attempt (n = 111), naltrexone use was associated with an increased likelihood of favorable TB outcomes (92.3% versus 75.9%, P = 0.02).
In Tomsk Oblast, Russia, tuberculosis patients with severe alcohol use disorders who were not seeking alcohol treatment did not respond to naltrexone or behavioral counselling integrated into tuberculosis care; however, those patients with past attempts to quit drinking had improved tuberculosis outcomes.
在俄罗斯托木斯克，检验简短咨询干预（BCI）和纳曲酮整合到结核病（TB）治疗中的可行性和有效性。
采用析因随机对照试验设计，患者被随机分为纳曲酮（NTX）、简短行为依从性增强治疗（BBCET）、常规治疗（TAU）和 BCI 组。
在托木斯克州，在开始结核病治疗时，通过 DSM-IV 诊断患有酒精使用障碍（AUD）的住院结核病患者被转诊。196 名参与者中，平均年龄为 41 岁，82%为男性。严重结核病（84.7%有空腔疾病）和吸烟（92.9%）很常见。大多数人有 AUD 诊断（63.0%）；27.6%报告几乎每天饮酒，平均每天饮用 16 标准杯。
主要结果是“有利”的结核病结局（治愈、完成治疗）和与基线相比，研究最后一个月平均无饮酒天数的变化。次要结果是衡量药物依从性的定义为每天饮用 4 杯和 5 杯的重度饮酒天数的变化，女性和男性分别为每天饮用 4 杯和 5 杯，以及直接观察下规定剂量的百分比。多变量分析采用意向治疗进行分析。
纳曲酮和无纳曲酮或 BCI 和无 BCI 组之间的主要结核病和酒精终点没有显著差异。治疗组之间的治疗依从性和重度饮酒天数的变化也没有显著差异。在有既往戒烟尝试的个体中（n=111），纳曲酮的使用与有利的结核病结局的可能性增加相关（92.3%与 75.9%，P=0.02）。
在俄罗斯托木斯克州，患有严重酒精使用障碍且不寻求酒精治疗的结核病患者对纳曲酮或整合到结核病护理中的行为咨询没有反应；然而，那些有过去尝试戒酒的患者结核病结局有所改善。
