纳米比亚艾滋病毒感染者结核预防治疗接受情况评估：多方法分析。

Evaluation of the uptake of tuberculosis preventative therapy for people living with HIV in Namibia: a multiple methods analysis.

机构信息

U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.

Ministry of Health and Social Services of Namibia, Directorate of Special Programs, Oshakati, Namibia.

出版信息

BMC Public Health. 2020 Dec 1;20(1):1838. doi: 10.1186/s12889-020-09902-z.

DOI:10.1186/s12889-020-09902-z

PMID:33261569

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7708912/

Abstract

BACKGROUND

In 2016, Namibia had ~ 230,000 people living with HIV (PLHIV) and 9154 new tuberculosis (TB) cases, including 3410 (38%) co-infected cases. TB preventative therapy (TPT), consisting of intensive case finding and isoniazid preventative therapy, is critical to reducing TB disease and mortality.

METHODS

Between November 2014 and February 2015, data was abstracted from charts of PLHIV enrolled in HIV treatment. Fifty-five facilities were purposively selected based on patient volume, type and location. Charts were randomly sampled. The primary outcome was to estimate baseline TPT in PLHIV, using nationally weighted proportions. Qualitative surveys were conducted and summarized to evaluate TPT practices and quantify challenges encountered by health care workers (HCW).

RESULTS

Among 861 PLHIV sampled, 96% were eligible for TPT services, of which 87.1% were screened for TB at least once. For PLHIV eligible for preventative therapy (646/810; 82.6%), 45.4% (294/646) initiated therapy and 45.7% (139/294) of those completed therapy. The proportion of eligible PLHIV completing TB screening, initiating preventative therapy and then completing preventative therapy was 20.7%. Qualitative surveys with 271 HCW identified barriers to TPT implementation including: lack of training (61.3% reported receiving training on TPT); misunderstandings about timing of TPT initiation (46.7% correctly reported TPT should be started with antiretroviral therapy); and variable screening practices and responsibilities (66.1% of HCWs screened for TB at every encounter). Though barriers were evident, 72.2% HCWs surveyed described their clinical performance as very good, often placing responsibility of difficulties on patients and downplaying challenges like staff shortages and medication stock outs.

CONCLUSIONS

In this study, only 1 in 5 eligible PLHIV completed the TPT cascade in Namibia. Lack of training, irregularities with TB screening and timing of TPT, unclear prescribing and recording responsibilities, and a clinical misperception may have contributed to suboptimal programmatic implementation. Addressing these challenges will be critical with continued TPT scale-up.

摘要

背景

2016 年，纳米比亚有大约 23 万名艾滋病毒感染者（PLHIV）和 9154 例新的结核病（TB）病例，其中包括 3410 例（38%）合并感染病例。结核预防治疗（TPT）包括强化病例发现和异烟肼预防治疗，对减少结核病发病和死亡至关重要。

方法

2014 年 11 月至 2015 年 2 月期间，从纳入 HIV 治疗的 PLHIV 病历中提取数据。根据患者数量、类型和地点，有针对性地选择了 55 个设施。对病历进行随机抽样。主要结果是使用全国加权比例估计 PLHIV 的 TPT 基线情况。进行了定性调查并进行了总结，以评估 TPT 实践，并量化卫生保健工作者（HCW）遇到的挑战。

结果

在 861 名被抽样的 PLHIV 中，96%有资格接受 TPT 服务，其中 87.1%至少接受过一次结核病筛查。在有资格接受预防治疗的 PLHIV（646/810；82.6%）中，45.4%（294/646）开始接受治疗，45.7%（139/294）完成治疗。有资格完成结核病筛查、开始预防治疗然后完成预防治疗的 PLHIV 比例为 20.7%。对 271 名 HCW 的定性调查发现了 TPT 实施的障碍，包括：缺乏培训（61.3%报告接受了 TPT 培训）；对 TPT 启动时机的误解（46.7%正确报告 TPT 应在抗逆转录病毒治疗时开始）；以及筛查做法和责任的差异（66.1%的 HCWs在每次就诊时都筛查结核病）。尽管存在障碍，但接受调查的 72.2%HCW 表示他们的临床表现非常好，经常将困难归咎于患者，而淡化工作人员短缺和药物库存不足等挑战。