南非公立初级保健患者中结核病 (TB) 和抗逆转录病毒 (ARV) 药物不依从的预测因素：一项横断面研究。
Predictors of tuberculosis (TB) and antiretroviral (ARV) medication non-adherence in public primary care patients in South Africa: a cross sectional study.
机构信息
Department of Psychology, University of the Western Cape, Cape Town, South Africa.
出版信息
BMC Public Health. 2013 Apr 26;13:396. doi: 10.1186/1471-2458-13-396.
BACKGROUND
Despite the downward trend in the absolute number of tuberculosis (TB) cases since 2006 and the fall in the incidence rates since 2001, the burden of disease caused by TB remains a global health challenge. The co-infection between TB and HIV adds to this disease burden. TB is completely curable through the intake of a strict anti-TB drug treatment regimen which requires an extremely high and consistent level of adherence.The aim of this study was to investigate factors associated with adherence to anti-TB and HIV treatment drugs.
METHODS
A cross-sectional survey method was used. Three study districts (14 primary health care facilities in each) were selected on the basis of the highest TB caseload per clinic. All new TB and new TB retreatment patients were consecutively screened within one month of anti-tuberculosis treatment. The sample comprised of 3107 TB patients who had been on treatment for at least three weeks and a sub-sample of the total sample were on both anti-TB treatment and anti-retro-viral therapy(ART) (N = 757). Data collection tools included: a Socio-Demographic Questionnaire; a Post-Traumatic-Stress-Disorder (PTSD) Screen; a Psychological Distress Scale; the Alcohol Use Disorder Identification Test (AUDIT); and self-report measures of tobacco use, perceived health status and adherence to anti-TB drugs and ART.
RESULTS
The majority of the participants (N = 3107) were new TB cases with a 55.9% HIV co-infection rate in this adult male and female sample 18 years and older. Significant predictors of non-adherence common to both anti-TB drugs and to dual therapy (ART and anti-TB drugs) included poverty, having one or more co-morbid health condition, being a high risk for alcohol mis-use and a partner who is HIV positive. An additional predictor for non-adherence to anti-TB drugs was tobacco use.
CONCLUSIONS
A comprehensive treatment programme addressing poverty, alcohol mis-use, tobacco use and psycho-social counseling is indicated for TB patients (with and without HIV). The treatment care package needs to involve not only the health sector but other relevant government sectors, such as social development.
背景
尽管自 2006 年以来结核病（TB）病例的绝对数量呈下降趋势，自 2001 年以来发病率也有所下降，但结核病造成的疾病负担仍然是全球卫生挑战。TB 和 HIV 的合并感染增加了这种疾病负担。通过服用严格的抗 TB 药物治疗方案，结核病是完全可以治愈的，这需要极高且一致的依从性。本研究旨在调查与抗 TB 和 HIV 治疗药物依从性相关的因素。
方法
采用横断面调查方法。根据每个诊所最高的 TB 病例数，选择了三个研究区（每个区有 14 个初级保健设施）。在抗结核治疗开始后的一个月内，连续筛查所有新的 TB 和新的 TB 复治患者。该样本包括已经接受治疗至少三周的 3107 名 TB 患者，以及总样本的一部分同时接受抗 TB 治疗和抗逆转录病毒治疗（ART）的患者（N=757）。数据收集工具包括：社会人口学问卷；创伤后应激障碍（PTSD）筛查；心理困扰量表；酒精使用障碍识别测试（AUDIT）；以及自我报告的烟草使用、感知健康状况以及对抗 TB 药物和 ART 的依从性。
结果
大多数参与者（N=3107）是新的 TB 病例，在这个年龄在 18 岁及以上的成年男女样本中，HIV 合并感染率为 55.9%。与抗 TB 药物和双重治疗（ART 和抗 TB 药物）不依从的共同显著预测因素包括贫困、有一个或多个合并健康状况、高酒精滥用风险和 HIV 阳性的伴侣。对 TB 药物不依从的另一个预测因素是烟草使用。
结论
需要针对 TB 患者（无论是否感染 HIV）制定一个综合性的治疗方案，解决贫困、酒精滥用、烟草使用和心理社会咨询问题。治疗护理套餐不仅需要涉及卫生部门，还需要涉及社会发展等其他相关政府部门。
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