Bristow Claire C, Podewils Laura Jean, Bronner Liza Ellen, Bantubani Nonkqubela, Walt Martie van der, Peters Annatjie, Mametja David
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention(CDC), 1600 Clifton Road NE, MS E-10, Atlanta, Georgia 30333, USA.
BMC Public Health. 2013 Sep 4;13:801. doi: 10.1186/1471-2458-13-801.
In 2008-2009 the South African National Tuberculosis (TB) Program (NTP) implemented a national pilot project, the TB Tracer Project, aiming to decrease default rates and improve patient outcomes. The current study aimed to inform the NTP by describing the knowledge, attitudes, and practices of TB program personnel involved with tracing activities.
A self-administered written questionnaire was sent to TB staff, managers and tracer team leaders to assess basic TB knowledge, attitudes and practices. Descriptive statistics were used to summarize results and the chi-squared statistic was used to compare responses of staff at facilities that participated in the TB Tracer Project (tracer) and those that followed standard NTP care (non-tracer).
Of 560 total questionnaires distributed, 270 were completed and returned (response rate 48%). Total TB knowledge ranged from 70.8-86.3% correct across all response groups. However, just over half (range 50-59.3%) of each respondent group was able to correctly identify the four components of a DOT encounter. A patient no longer feeling sick was cited by 72.1% of respondents as the reason patients fail to adhere to treatment. Tracer teams were viewed as an effective means to get patients to return to treatment by 96.3% of health facility level respondents. Tracer team leaders reported concerns including lack of logistical support (41.7%), insufficient physical safety precautions (41.7%), and inadequate protection from contracting TB (39.1%). Upon patients returning to treatment at the clinic, facilities included in the TB Tracer Project were significantly more likely to discuss alternate DOTS arrangements than non-tracer facilities (79.2 vs. 66.4%, p = 0.03).
This study identified key components of knowledge, attitudes, and practices regarding TB patient tracing activities in South Africa. Educating patients on the essential need to complete treatment irrespective of clinical symptoms may help improve treatment adherence. Future scale-up and integration of TB tracing activities as part of standard TB management should include provisions for standardized training of personnel on the critical elements of DOTS, and for ensuring appropriate supervision, logistical support, and physical safety and TB transmission protection of tracing teams.
2008 - 2009年，南非国家结核病项目（NTP）实施了一项全国性试点项目，即结核病追踪项目，旨在降低失访率并改善患者治疗效果。本研究旨在通过描述参与追踪活动的结核病项目人员的知识、态度和实践情况，为NTP提供信息。
向结核病工作人员、管理人员和追踪团队负责人发放一份自行填写的书面问卷，以评估他们对结核病的基本知识、态度和实践情况。使用描述性统计方法总结结果，并使用卡方统计量比较参与结核病追踪项目的机构（追踪机构）和遵循标准NTP护理的机构（非追踪机构）工作人员的回答。
在总共发放的560份问卷中，有270份填写并返回（回复率48%）。所有回复组的结核病知识总正确率在70.8%至86.3%之间。然而，每个回复组中只有略超过一半（范围为50%至59.3%）的人能够正确识别直接观察治疗（DOT）接触的四个组成部分。72.1%的受访者认为患者不再感觉生病是患者不坚持治疗的原因。96.3%的医疗机构层面受访者认为追踪团队是促使患者重新接受治疗的有效手段。追踪团队负责人报告了一些担忧，包括缺乏后勤支持（41.7%）、人身安全预防措施不足（41.7%）以及预防感染结核病的保护措施不足（39.1%）。在患者返回诊所接受治疗时，参与结核病追踪项目的机构比非追踪机构更有可能讨论替代的直接观察治疗安排（79.2%对66.4%，p = 0.03）。
本研究确定了南非结核病患者追踪活动在知识、态度和实践方面的关键组成部分。对患者进行关于无论临床症状如何都必须完成治疗的必要性的教育，可能有助于提高治疗依从性。未来将结核病追踪活动作为标准结核病管理的一部分进行扩大规模和整合时，应包括对人员进行关于直接观察治疗关键要素的标准化培训的规定，以及确保对追踪团队进行适当监督、后勤支持、人身安全和结核病传播防护的规定。
