Wei X-L, Yin J, Zou G-Y, Zhang Z-T, Walley J, Harwell J, Li H-T, Sun Q, Li R-Z, Wang L-X, Zhang X-L
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
Nuffield Centre for International Health and Development, University of Leeds China Office, Shenzhen, China.
Int J Tuberc Lung Dis. 2015 Apr;19(4):413-9. doi: 10.5588/ijtld.14.0485.
China has nearly one fifth of global multidrug-resistant tuberculosis (MDR-TB) cases, and follows the 24-month World Health Organization (WHO) standardised regimens.
To assess treatment interruption among MDR-TB patients and its association with the provision of directly observed treatment (DOT).
We reviewed clinical charts and conducted a questionnaire survey among all confirmed MDR-TB patients who had been treated for at least 6 months from 1 January 2009 to 30 April 2012 in Shandong Province. Treatment interruption was defined as missing a dose for at least 1 day but for <8 consecutive weeks; the subset 'severe interruption' was defined as missing doses for 2-8 consecutive weeks.
Of 110 patients, 75 (68%) interrupted treatment; 19 (17%) reported severe interruption, with a median duration of 30 days. Of the 110 patients, 26 (24%) received injections from family members and 55 (50%) received DOT, 7 (13%) from village doctors and 48 (87%) from family members. Patients who underwent DOT with a family member had less severe interruptions (OR 0.25, 95%CI 0.05-0.98) than those who were given DOT by a village doctor or who did not undergo DOT.
Family members may act as treatment supporters for MDR-TB patients to reduce treatment interruptions, but require orientation on their role.
中国的耐多药结核病（MDR-TB）病例数占全球近五分之一，并遵循世界卫生组织（WHO）的24个月标准化治疗方案。
评估耐多药结核病患者的治疗中断情况及其与直接观察治疗（DOT）提供的关联。
我们回顾了山东省2009年1月1日至2012年4月30日期间所有确诊且接受治疗至少6个月的耐多药结核病患者的临床病历并进行了问卷调查。治疗中断定义为漏服一剂至少1天但连续<8周；“严重中断”子集定义为连续2 - 8周漏服剂量。
110例患者中，75例（68%）中断治疗；19例（17%）报告严重中断，中位持续时间为30天。110例患者中，26例（24%）接受家庭成员注射，55例（50%）接受DOT，7例（13%）由乡村医生提供，48例（87%）由家庭成员提供。由家庭成员进行DOT的患者比由乡村医生进行DOT或未接受DOT的患者严重中断情况更少（比值比0.25，95%置信区间0.05 - 0.98）。
家庭成员可作为耐多药结核病患者的治疗支持者以减少治疗中断，但需要对其角色进行指导。
