Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India.
Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, Chennai, India.
PLoS One. 2023 Jan 26;18(1):e0280812. doi: 10.1371/journal.pone.0280812. eCollection 2023.
Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations.
This prospective observational study was conducted in Chennai Corporation treatment units during 2019-2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status.
A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44-58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150-180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46-55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p<0.05) and illiterates were found more likely to disclose their TB status (AOR 3.91; p<0.05). Post the disclosure, family contacts have mostly provided resource support (44.90%) and two third of all disclosed contacts have provided emotional support for TB patients (>71%).
Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings could inform in developing interventions to facilitate disclosure of disease status in a beneficial way for TB patients.
患者披露结核病（TB）状况是其治疗护理级联中的关键步骤。然而，目前缺乏对患者与家人及更广泛的社会网络关系进行动态评估 TB 披露模式及其积极结果的系统评估。
本前瞻性观察性研究于 2019 年至 2021 年在钦奈市治疗单位进行。从治疗开始到完成，招募并随访 TB 患者。收集并比较不同时间点向不同社会成员披露疾病的信息，以及结局。使用双变量和多变量分析来确定预测 TB 披露状况的患者和接触者特征。
共随访了 466 例 TB 患者，共列出了 4039 名家庭成员、非家庭成员和社会网络联系人。与家人（93%）的交流最多，有一半的亲戚、职业接触者和友谊接触者（44-58%）在治疗开始后 15 天内被披露。在治疗的 150-180 天期间，邻里接触者（12%）进行了最多的增量披露，且在治疗开始和结束期间差异显著。中年 TB 患者（31 岁和 46-55 岁）不太可能披露（AOR 分别为 0.56 和 0.46；p<0.05），且文盲更有可能披露其 TB 状况（AOR 3.91；p<0.05）。披露后，家人接触者大多提供资源支持（44.90%），所有披露接触者中有三分之二为 TB 患者提供了情感支持（>71%）。
研究结果表明，家庭层面的披露是主要的，且在治疗后期，对非家庭网络接触者的披露显著增加。TB 患者在披露后主要从所有接触者那里获得情感支持。研究结果可以为制定干预措施提供信息，以有利于 TB 患者的方式促进疾病状况的披露。
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