Howell Embry M, Kigozi N Gladys, Heunis J Christo
The Urban Institute, Health Policy Center, 2100 M St., N.W, Washington, D.C., 20037, USA.
Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa.
BMC Health Serv Res. 2018 Apr 7;18(1):255. doi: 10.1186/s12913-018-3074-1.
There is uncertainty about how directly observed treatment (DOT) support for tuberculosis (TB) can be delivered most effectively and how DOT support can simultaneously be used to strengthen human immunodeficiency virus (HIV) prevention and control among TB patients. This study describes how DOT support by community health workers (CHWs) was used in four municipalities in the Free State province - a high TB/HIV burden, poorly-resourced setting - to provide HIV outreach, referrals, and health education for TB patients.
The study was part of a larger cross-sectional study of HIV counselling and testing (HCT) among 1101 randomly-selected TB patients registered at 40 primary health care (PHC) facilities (clinics and community health centres) across small town/rural and large town/urban settings. Univariate analysis of percentages, chi-square tests and t-tests for difference in means were used to describe differences between the types of TB treatment support and patient characteristics, as well as the types of - and patient satisfaction with - HIV information and referrals received from various types of treatment supporters including home-based DOT supporters, clinic-based DOT supporters or support from family/friends/employers. Multivariate logistic regression was used to predict the likelihood of not having receiving home-based DOT and of never having received HIV counselling. The independent variables include poverty-related health and socio-economic risk factors for poor outcomes. Statistical significance is shown using a 95% confidence interval and a 0.05 p-value.
Despite the fact that DOT support for all TB patients was the goal of South African health policy at the time (2012), most TB patients were not receiving formal DOT support. Only 155 (14.1%) were receiving home-based DOT, while 114 (10.4%) received clinic-based DOT. TB patients receiving home-based DOT reported higher rates of HIV counselling than other patients.
Public health providers should train DOT supporters to provide HIV prevention and target DOT to those at greatest risk of HIV, particularly those at greatest socio-economic risk.
对于如何最有效地提供直接观察治疗（DOT）以支持结核病（TB）治疗，以及如何同时利用DOT支持来加强结核病患者中的人类免疫缺陷病毒（HIV）预防和控制，目前尚不确定。本研究描述了在自由邦省的四个市（该地区结核病/艾滋病负担高且资源匮乏），社区卫生工作者（CHW）如何利用DOT支持为结核病患者提供HIV外展服务、转诊和健康教育。
该研究是一项更大规模横断面研究的一部分，该横断面研究针对在40个初级卫生保健（PHC）机构（诊所和社区卫生中心）登记的1101名随机选择的结核病患者进行HIV咨询和检测（HCT），这些机构分布在小镇/农村和大镇/城市地区。使用百分比的单变量分析、卡方检验和均值差异的t检验来描述结核病治疗支持类型与患者特征之间的差异，以及从包括家庭DOT支持者、诊所DOT支持者或家人/朋友/雇主提供的支持等各类治疗支持者处获得的HIV信息和转诊的类型及患者满意度。多变量逻辑回归用于预测未接受家庭DOT和从未接受HIV咨询的可能性。自变量包括与贫困相关的健康和不良结局的社会经济风险因素。使用95%置信区间和0.05的p值显示统计学显著性。
尽管当时（2012年）南非卫生政策的目标是为所有结核病患者提供DOT支持，但大多数结核病患者并未获得正式的DOT支持。只有155名（14.1%）患者接受家庭DOT，而114名（10.4%）接受诊所DOT。接受家庭DOT的结核病患者报告的HIV咨询率高于其他患者。
公共卫生提供者应培训DOT支持者提供HIV预防服务，并将DOT针对HIV感染风险最高的人群，特别是社会经济风险最高的人群。
