Internal Medicine, McGovern Medical School at the University of Texas Health Science Center - Houston, Houston, Texas, USA
Psychiatry, University of California San Francisco, San Francisco, California, USA.
BMJ Open. 2020 Feb 2;10(1):e032027. doi: 10.1136/bmjopen-2019-032027.
To understand the challenges faced by patients with tuberculosis (TB) and factors that influence TB treatment adherence in Ukraine.
Qualitative study.
TB treatment facilities in Kyiv Oblast, Ukraine.
Sixty adults who had undergone treatment for drug-sensitive TB between June 2012 and August 2015.
We conducted semistructured, in-depth, individual interviews among a purposively selected clinical sample of patients previously treated for drug-sensitive TB. Interview content encompassed WHO's framework for barriers to adherence to long-term therapies and included questions about patient preferences and motivators concerning treatment adherence. We examined treatment experience across strata defined by previously identified risk correlates of non-adherence.
Among 60 participants, 19 (32.8%) were HIV positive, 12 (20.3%) had substance use disorder and 9 (15.0%) had not completed TB treatment. Respondents discussed the psychological distress associated with hospital-based TB care, as well as perceived unsupportive, antagonistic interactions with TB providers as major challenges to treatment adherence. An additional barrier to successful treatment completion included the financial toll of lost income during TB treatment, which was exacerbated by the additional costs of ancillary medications and transportation to ambulatory TB clinics. The high pill burden of TB treatment also undermined adherence. These challenges were endorsed among participants with and without major risk factors for non-adherence.
Our findings highlight important barriers to TB treatment adherence in this study population and suggest specific interventions that may be beneficial in mitigating high rates of poor treatment outcomes for TB in Ukraine.
了解乌克兰结核病（TB）患者面临的挑战以及影响 TB 治疗依从性的因素。
定性研究。
乌克兰基辅地区的 TB 治疗机构。
60 名曾在 2012 年 6 月至 2015 年 8 月间接受过药物敏感型 TB 治疗的成年人。
我们在一项以前接受过药物敏感型 TB 治疗的临床患者中进行了半结构式、深入的个人访谈，这是一项有目的的选择。访谈内容包括世界卫生组织（WHO）关于长期治疗依从性障碍的框架，并包括关于患者对治疗依从性的偏好和动机的问题。我们根据以前确定的非依从性风险相关性，检查了不同治疗经验的人群。
在 60 名参与者中，有 19 人（32.8%）HIV 阳性，12 人（20.3%）有药物使用障碍，9 人（15.0%）未完成 TB 治疗。受访者讨论了与医院 TB 护理相关的心理困扰，以及与 TB 提供者之间被认为不支持、对抗性的互动，这是治疗依从性的主要挑战。成功完成治疗的另一个障碍包括在 TB 治疗期间失去收入的经济代价，而辅助药物和前往流动 TB 诊所的交通费用的额外成本则使这一问题更加严重。TB 治疗的高药丸负担也破坏了依从性。这些挑战在有和没有非依从性主要风险因素的参与者中都得到了认可。
我们的研究结果强调了该研究人群中 TB 治疗依从性的重要障碍，并提出了一些可能有助于减轻乌克兰 TB 治疗不良结局发生率高的具体干预措施。
