National Research and Innovation Agency (BRIN), Cibinong, Indonesia.
BKPK Indonesia Ministry of Health, Jakarta Selatan, Indonesia.
PLoS One. 2023 Aug 8;18(8):e0287628. doi: 10.1371/journal.pone.0287628. eCollection 2023.
Tuberculosis (TB) is the world's major public health problem. We assessed the proportion, reasons, and associated factors for anti-TB treatment nonadherence in the communities in Indonesia.
This national coverage cross-sectional survey was conducted from 2013 to 2014 with stratified multi-stage cluster sampling. Based on the region and rural-urban location. The 156 clusters were distributed in 136 districts/cities throughout 33 provinces, divided into three areas. An eligible population of age ≥15 was interviewed to find TB symptoms and screened with a thorax x-ray. Those whose filtered result detected positive followed an assessment of Sputum microscopy, LJ culture, and Xpert MTB/RIF. Census officers asked all participants about their history of TB and their treatment-defined Nonadherence as discontinuation of anti-tuberculosis treatment for <6 months. Data were analyzed using STATA 14.0 (College Station, TX, USA).
Nonadherence to anti-TB treatment proportion was 27.24%. Multivariate analysis identified behavioral factors significantly associated with anti-TB treatment nonadherence, such as smoking (OR = 1.78, 95% CI (1.47-2.16)); place of first treatment received: government hospital (OR = 1.45, 95% CI:1.06-1.99); private hospital (OR = 1.93, 95% CI: 1.38-2.72); private practitioner (OR = 2.24, 95% CI: 1.56-3.23); socio-demographic and TB status included region: Sumatera (OR = 1.44, 95% CI: 1.05-1.98); other areas (OR = 1.84, 95% CI: 1.30-2.61); low level of education (OR = 1.60, 95% CI: 1.27-2.03); and current TB positive status (OR = 2.17, 95% CI: 1.26-3.73).
Nonadherence to anti-TB drugs was highly related to the personal perception of the respondents, despite smoking, current TB status, a place for the first treatment, education, and region. The position of the first TB treatment at the private practitioner was significantly associated with the risk of Nonadherence to treatment.
结核病（TB）是全球主要的公共卫生问题。我们评估了印度尼西亚社区中抗结核治疗不依从的比例、原因和相关因素。
本项全国性覆盖的横断面调查于 2013 年至 2014 年进行，采用分层多阶段聚类抽样。根据地区和城乡位置，156 个聚类分布在全国 33 个省的 136 个区/市中，分为三个区域。对年龄≥15 岁的合格人群进行访谈，以发现结核病症状，并进行胸部 X 光检查。对过滤结果呈阳性的人进行痰显微镜检查、LJ 培养和 Xpert MTB/RIF 评估。普查人员询问所有参与者的结核病史及其治疗定义的不依从情况，即抗结核治疗中断<6 个月。使用 STATA 14.0（美国德克萨斯州大学城）进行数据分析。
抗结核治疗不依从的比例为 27.24%。多变量分析确定了与抗结核治疗不依从显著相关的行为因素，如吸烟（OR=1.78，95%CI（1.47-2.16））；首次治疗地点：政府医院（OR=1.45，95%CI：1.06-1.99）；私立医院（OR=1.93，95%CI：1.38-2.72）；私人医生（OR=2.24，95%CI：1.56-3.23）；社会人口统计学和结核病状况包括地区：苏门答腊（OR=1.44，95%CI：1.05-1.98）；其他地区（OR=1.84，95%CI：1.30-2.61）；教育程度低（OR=1.60，95%CI：1.27-2.03）；和当前结核病阳性状态（OR=2.17，95%CI：1.26-3.73）。
尽管与个人对吸烟、当前结核病状况、首次治疗地点、教育和地区的看法有关，但抗结核药物的不依从性与个人感知高度相关。首次结核病治疗的地点在私人医生处与治疗不依从的风险显著相关。
