Kumar Blessina Amulya
Health Activist & Public Health Consultant, CEO (Interim) Global Coalition of TB Activists, India.
Int J Mycobacteriol. 2016 Dec;5 Suppl 1:S129-S130. doi: 10.1016/j.ijmyco.2016.11.021. Epub 2016 Nov 27.
To highlight the need for post-treatment rehabilitation of TB patient; including social psychological and economic aspects.
Patient interaction, informal interviews, field observations and secondary research. The minimum duration of treatment (for drug-susceptible TB) is 6months. Treatment for drug-resistant TB can be from anywhere between 18 and 24months. In some cases treatment can last for more than 5years. Despite this, little attention is given to the social, psychological and economic impact extended treatment can have on the lives of individuals. Due, to a large extent, to the high levels of stigma that continue to exist in many high-burden countries, people affected must face obstacles even before diagnosis. These challenges persist at every stage of the treatment process (diagnosis, accessing appropriate care, treatment and post-treatment), but impact the individual's lives in various ways. Research has shown that despite diagnosis and treatment being provided for free, most individuals have to face high out-of-pocket expenditure (on transport, additional medication, nutritional supplementation etc.). In many countries, these expenses often have a significant negative impact on family finances. In most national programs, pre-treatment counselling is not included. This means that those affected are not prepared for the implications (in terms of time, money and physiological effects) that their treatment can have.
The side effects of TB medication (especially DR-TB) are sometimes extreme, and require extensive therapy and/or rehabilitation. Some side effects such as hearing-loss are often permanent. Nutritional support is another key factor that receives little attention in national programs. Adding to all these physiological challenges is the constant stigma and discrimination that individuals face from friends, family and even healthcare workers. Returning to jobs or to their education is a challenge as many workplaces and educational institutions do not provide for extended periods of leave or absence. This is costly both in terms of time and money. In families where the primary "bread winner" needs to undergo intensive treatment, the reduced income can have a devastating effect.
Therefore despite having completed treatment, many people continue to suffer. Hence it is necessary that robust systems for post-treatment rehabilitation are put in place, and are designed based on the needs of those affected. Peer to peer counselling can be a low-cost high-impact strategy to address some of these issues. Institutional provisions, under the national response in each country, must be put in place if individuals are to successfully complete treatment, and return to their normal lives.
强调结核病患者治疗后康复的必要性，包括社会、心理和经济方面。
患者互动、非正式访谈、实地观察和二手研究。（对于药物敏感型结核病）最短治疗时长为6个月。耐多药结核病的治疗时长可能在18至24个月之间。在某些情况下，治疗可能持续超过5年。尽管如此，延长治疗对个人生活可能产生的社会、心理和经济影响却很少受到关注。在很大程度上，由于许多高负担国家仍然存在严重的污名化现象，患者在确诊之前就必须面对重重障碍。这些挑战在治疗过程的每个阶段（诊断、获得适当护理、治疗和治疗后）都持续存在，但以各种方式影响着个人生活。研究表明，尽管诊断和治疗是免费提供的，但大多数患者仍需承担高额的自付费用（用于交通、额外药物、营养补充等）。在许多国家，这些费用往往对家庭财务产生重大负面影响。在大多数国家项目中，治疗前咨询并不包括在内。这意味着患者对治疗可能产生的影响（在时间、金钱和生理影响方面）没有做好准备。
结核病药物（尤其是耐多药结核病药物）的副作用有时非常严重，需要广泛的治疗和/或康复。一些副作用，如听力丧失，往往是永久性的。营养支持是国家项目中另一个很少受到关注的关键因素。除了所有这些生理挑战外，患者还不断面临来自朋友、家人甚至医护人员的污名和歧视。重返工作岗位或继续学业是一项挑战，因为许多工作场所和教育机构不提供长时间的休假。这在时间和金钱方面都代价高昂。在主要“挣钱养家者”需要接受强化治疗的家庭中，收入减少可能会产生毁灭性影响。
因此，尽管已经完成治疗，许多人仍在受苦。因此，有必要建立强大的治疗后康复系统，并根据患者的需求进行设计。同伴辅导可能是解决其中一些问题的低成本、高影响力策略。如果个人要成功完成治疗并回归正常生活，每个国家在国家应对措施下必须制定机构规定。
