Deshmukh R D, Dhande D J, Sachdeva K S, Sreenivas A N, Kumar A M V, Parmar M
WHO Country Office for India, New Delhi, India; National AIDS Control Organisation, Ministry of Health and Family Welfare, New Delhi, India.
DR TB Centre NKPS and LMH Nagpur, Maharashtra, India.
Indian J Tuberc. 2018 Jan;65(1):41-47. doi: 10.1016/j.ijtb.2017.05.003. Epub 2017 Jun 2.
Multidrug-resistant tuberculosis (MDR-TB) is emerging as a major public health problem globally. Treatment success rates in MDR-TB across the globe are not encouraging as completing MDR-TB treatment successfully is challenging due to high proportion of lost to follow up.
Using qualitative methods and grounded theory approach, in-depth interviews were conducted with MDR-TB patients and treatment providers. The social cognitive framework was explored as a way to guide understanding of the factors affecting treatment adherence among MDR-TB patients.
Multiple factors influenced patient's decision to adhere to MDR-TB treatment. Self-motivation, awareness about disease and treatment, counselling support, family support, nutritional support and social support were important drivers for successful treatment. Providers related that motivational counselling, nutritional support, family support and social support encouraged treatment adherence.
To improve MDR-TB treatment adherence, a patient-centric approach should be considered at the programmatic level. There is a need to formulate strategy that includes motivational counselling, nutritional supplementation and social support mobilisation for treatment adherence. Participants suggested a Patient Support Group led treatment care model for better adherence and treatment success rates in MDR-TB treatment.
耐多药结核病（MDR-TB）正在成为全球主要的公共卫生问题。由于失访比例高，成功完成耐多药结核病治疗具有挑战性，因此全球耐多药结核病的治疗成功率并不乐观。
采用定性方法和扎根理论方法，对耐多药结核病患者和治疗提供者进行了深入访谈。探索了社会认知框架，作为指导理解影响耐多药结核病患者治疗依从性因素的一种方式。
多种因素影响患者坚持耐多药结核病治疗的决定。自我激励、对疾病和治疗的认识、咨询支持、家庭支持、营养支持和社会支持是成功治疗的重要驱动因素。提供者表示，动机咨询、营养支持、家庭支持和社会支持可鼓励治疗依从性。
为提高耐多药结核病治疗的依从性，应在项目层面考虑以患者为中心的方法。有必要制定一项战略，包括动机咨询、营养补充和动员社会支持以促进治疗依从性。参与者建议采用患者支持小组主导的治疗护理模式，以提高耐多药结核病治疗的依从性和治疗成功率。
