Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America.
Kongwa Trachoma Project, Kongwa, United Republic of Tanzania.
PLoS One. 2021 Mar 19;16(3):e0247994. doi: 10.1371/journal.pone.0247994. eCollection 2021.
Post-surgical follow-up is a challenge in low- and middle-income countries. Understanding barriers to trachomatous trichiasis (TT) surgical follow-up can inform program improvements. In this study, patient perceived barriers and enabling factors to follow-up after TT surgery are identified.
A longitudinal study was carried out in a community-based cohort of persons who received TT surgery in Bahi district, Tanzania. Questionnaires were administered before TT surgery and again after the scheduled 6-month follow-up. Those who did not return were examined at their homes.
At baseline, 852 participants were enrolled. Of these, 633 (74%) returned at 6 months and 128 (15%) did not and were interviewed at home. Prior to surgery, attenders were more likely to report familiarity with a community health worker (CHW) (22% vs. 14%; p = 0.01) and less likely to state that time constraints are a potential reason for failure to follow-up (66% vs. 74%; p = .04). At follow-up, non-attenders were more likely to endorse barriers pertaining to knowledge about the need for follow-up, lack of transportation, and satisfaction with surgery. There was no difference in post-operative TT between attenders and non-attenders (23% vs. 18% respectively; p = 0.25).
The outcome of surgery was not a barrier to follow-up. However, better integration of CHWs into their communities and work at coordinating post-surgical care may improve follow-up rates. Moreover, provision of transportation and implementation of effective reminder systems may address patient-perceived barriers to improve follow-up.
术后随访是中低收入国家面临的一项挑战。了解沙眼性倒睫（TT）手术后随访的障碍，可以为项目改进提供信息。本研究旨在确定患者在 TT 手术后随访的感知障碍和促进因素。
在坦桑尼亚巴希区，对接受 TT 手术的社区为基础的队列进行了一项纵向研究。在 TT 手术前和预定的 6 个月随访后进行问卷调查。未返回的患者在其家中接受检查。
在基线时，共纳入 852 名参与者。其中，633 名（74%）在 6 个月时返回，128 名（15%）未返回，并在家中接受了访谈。手术前，就诊者更有可能报告熟悉社区卫生工作者（CHW）（22%比 14%；p = 0.01），不太可能表示时间限制是未能随访的潜在原因（66%比 74%；p = 0.04）。在随访时，未就诊者更有可能认同与随访需求相关的知识、缺乏交通工具和对手术满意等障碍。就诊者和未就诊者术后 TT 的发生率无差异（分别为 23%和 18%；p = 0.25）。
手术结果不是随访的障碍。然而，更好地将 CHW 融入社区并协调术后护理工作可能会提高随访率。此外，提供交通和实施有效的提醒系统可能会解决患者对随访的感知障碍，以提高随访率。
