Raval Devang, Patel Parimal, Sharma Radhika, Shringarpure Kalpita
Department of Community Medicine, B. J. Medical College Ahmedabad, India.
Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India.
Indian J Tuberc. 2024 Jan;71(1):19-26. doi: 10.1016/j.ijtb.2023.03.005. Epub 2023 Mar 31.
Counselling sessions based on the health behaviour module for patients on TB treatment may help improve the level of understanding of tuberculosis and its treatment, importance of adherence to therapy, possible side effects, dietary habits and to address any misconceptions; leading to better adherence and improved outcome. Hence, study attempted to assess the impact of brief counselling intervention through treatment adherence supportive activist (TASA) in improving adherence to treatment among drug sensitive TB patients.
An explanatory mixed methods design (QUAN-Qual) was carried out. Out of 23 Tuberculosis units (TUs) in Ahmedabad Municipal Corporation (AMC) two were selected, one interventional group where trained counsellor was recruited while other was the control group. All drug sensitive TB patients diagnosed at both selected TUs during January to March 2020 were included in the study. Among all patients who were non-adherent in both the TUs, 14 were selected to explore factors contributing to non-adherence to treatment.
At the end of intensive phase, drug adherence in the study TU was 85.71% while it was 67.5% in the control TU. At the end of one month of treatment, the proportion of patients having better level adherence was more among counselled patients as compared to non-counselled patients. Marital status, religion, gender did not affect the level of adherence. Reasons for non-adherence as well as perceived barriers to adherence to TB treatment were treatment related, patient related and social barriers.
Dedicated NTEP counsellor (TASA) can help improve the treatment adherence and impact of physical counselling.
基于健康行为模块为结核病治疗患者开展咨询会议，可能有助于提高对结核病及其治疗的理解水平、坚持治疗的重要性、可能的副作用、饮食习惯，并消除任何误解，从而实现更好的治疗依从性并改善治疗效果。因此，本研究试图评估通过治疗依从性支持活动家（TASA）进行的简短咨询干预对提高药物敏感型结核病患者治疗依从性的影响。
采用解释性混合方法设计（定量-定性）。在艾哈迈达巴德市政公司（AMC）的23个结核病治疗单位（TUs）中，选择了两个，一个为干预组，招募了经过培训的咨询师，另一个为对照组。2020年1月至3月期间在两个选定治疗单位确诊的所有药物敏感型结核病患者均纳入研究。在两个治疗单位中所有不依从的患者中，选取了14名患者来探究导致治疗不依从的因素。
强化期结束时，研究治疗单位的药物依从率为85.71%，而对照治疗单位为67.5%。治疗一个月结束时，接受咨询的患者中依从性较好的患者比例高于未接受咨询的患者。婚姻状况、宗教信仰、性别均不影响依从水平。治疗不依从的原因以及结核病治疗依从性的感知障碍包括与治疗相关、与患者相关和社会方面的障碍。
专门的国家结核病防治规划咨询师（TASA）有助于提高治疗依从性和现场咨询的效果。
