Hirsch-Moverman Y, Shrestha-Kuwahara R, Bethel J, Blumberg H M, Venkatappa T K, Horsburgh C R, Colson P W
Charles P Felton National Tuberculosis Center, ICAP, Mailman School of Public Health, Columbia University, New York City, New York, USA.
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Int J Tuberc Lung Dis. 2015 Jan;19(1):31-8. doi: 10.5588/ijtld.14.0373.
To assess latent tuberculous infection (LTBI) treatment completion rates in a large prospective US/Canada multisite cohort and identify associated risk factors.
This prospective cohort study assessed factors associated with LTBI treatment completion through interviews with persons who initiated treatment at 12 sites. Interviews were conducted at treatment initiation and completion/cessation. Participants received usual care according to each clinic's procedure. Multivariable models were constructed based on stepwise assessment of potential predictors and interactions.
Of 1515 participants initiating LTBI treatment, 1323 had information available on treatment completion; 617 (46.6%) completed treatment. Baseline predictors of completion included male sex, foreign birth, not thinking it would be a problem to take anti-tuberculosis medication, and having health insurance. Participants in stable housing who received monthly appointment reminders were more likely to complete treatment than those without stable housing or without monthly reminders. End-of-treatment predictors of non-completion included severe symptoms and the inconvenience of clinic/pharmacy schedules, barriers to care and changes of residence. Common reasons for treatment non-completion were patient concerns about tolerability/toxicity, appointment conflicts, low prioritization of TB, and forgetfulness.
Less than half of treatment initiators completed treatment in our multisite study. Addressing tangible issues such as not having health insurance, toxicity concerns, and clinic accessibility could help to improve treatment completion rates.
评估美国/加拿大一项大型前瞻性多中心队列研究中潜伏性结核感染（LTBI）治疗的完成率，并确定相关风险因素。
这项前瞻性队列研究通过对在12个地点开始治疗的患者进行访谈，评估与LTBI治疗完成相关的因素。在治疗开始时以及完成/终止时进行访谈。参与者根据每个诊所的程序接受常规护理。基于对潜在预测因素和相互作用的逐步评估构建多变量模型。
在1515名开始LTBI治疗的参与者中，1323人有治疗完成情况的信息；617人（46.6%）完成了治疗。完成治疗的基线预测因素包括男性、外国出生、认为服用抗结核药物不会有问题以及拥有医疗保险。与没有稳定住房或没有每月提醒的参与者相比，居住稳定且收到每月预约提醒的参与者更有可能完成治疗。未完成治疗的治疗结束时预测因素包括严重症状以及诊所/药房日程安排的不便、就医障碍和居住地变更。治疗未完成的常见原因是患者对耐受性/毒性的担忧、预约冲突、对结核病的重视程度低以及健忘。
在我们的多中心研究中，不到一半的开始治疗者完成了治疗。解决诸如没有医疗保险、对毒性的担忧以及诊所可及性等实际问题有助于提高治疗完成率。
