Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.
Int J Tuberc Lung Dis. 2018 Oct 1;22(10):1152-1159. doi: 10.5588/ijtld.18.0129.
Home sputum collection could facilitate prompt evaluation and diagnosis of tuberculosis (TB) among contacts of patients with active TB. We analyzed barriers to home-based collection as part of an enhanced intervention for household TB contact investigation in Kampala, Uganda.
We conducted a convergent mixed-methods study to describe the outcomes of home sputum collection in 91 contacts and examine their context through 19 nested contact interviews and two focus group discussions with lay health workers (LHWs).
LHWs collected sputum from 35 (39%) contacts. Contacts reporting cough were more likely to provide sputum than those with other symptoms or risk factors (53% vs. 15%, RR 3.6, 95%CI 1.5-2.8, P < 0.001). Males were more likely than females to provide sputum (54% vs. 32%, RR 1.7, 95%CI 1.0-2.8, P = 0.05). Contacts said support from the index patient and the convenience of the home visit facilitated collection. Missing containers and difficulty producing sputum spontaneously impeded collection. Women identified stigma as a barrier. LHWs emphasized difficulty in procuring sputum and discomfort pressing contacts to produce sputum.
Home sputum collection by LHWs entails different challenges from sputum collection in clinical settings. More research is needed to develop interventions to mitigate stigma and increase success of home-based collection.
家庭痰标本采集可促进对活动性肺结核（TB）患者接触者的快速评估和诊断。我们分析了家庭痰标本采集的障碍，这是乌干达坎帕拉强化家庭结核接触者调查干预措施的一部分。
我们进行了一项收敛性混合方法研究，描述了 91 名接触者家庭痰标本采集的结果，并通过 19 次嵌套接触者访谈和 2 次与基层卫生工作者（LHW）的焦点小组讨论来检查其背景。
LHW 从 35 名（39%）接触者中采集了痰标本。有咳嗽症状的接触者比有其他症状或危险因素的接触者更有可能提供痰标本（53%比 15%，RR 3.6，95%CI 1.5-2.8，P < 0.001）。男性比女性更有可能提供痰标本（54%比 32%，RR 1.7，95%CI 1.0-2.8，P = 0.05）。接触者表示，来自索引患者的支持和家访的便利性促进了采集。缺少容器和难以自然产生痰液会阻碍采集。女性认为耻辱感是一个障碍。LHW 强调了难以采集痰液和接触者产生痰液时的不适。
LHW 进行家庭痰标本采集与临床环境中的痰标本采集有不同的挑战。需要进一步研究以开发干预措施，减轻耻辱感并提高家庭采集的成功率。
