Ngamvithayapong J, Uthaivoravit W, Yanai H, Akarasewi P, Sawanpanyalert P
College of Public Health, Chulalongkorn University, Bangkok, Thailand.
AIDS. 1997 Jan;11(1):107-12. doi: 10.1097/00002030-199701000-00016.
To determine the level of and reasons associated with adherence to tuberculosis preventive therapy among asymptomatic HIV-infected individuals in northern Thailand.
A prospective cohort study with a 9-month follow-up.
A total of 412 HIV-infected persons were enrolled in a tuberculosis preventive therapy programme in a hospital. A 9-month isoniazid regimen was prescribed. Adherence was determined by pill count. Participants who missed a scheduled appointment for more than a month were interviewed. Five focus group discussion sessions were held among those who successfully completed the therapy.
Of the 412 participants, 69.4% (286) completed the 9-month regimen. The adherence rate, defined as the proportion of those who took more than 80% of pills, was 67.5% (n = 278). Sex, source of participants and history of physical symptoms were associated with adherence. A significant portion of defaults took place at the beginning of the therapy. Out-migration, denial of HIV status, and perceived side effects of isoniazid were frequently cited as reasons for non-adherence. For those adhering participants, the acceptance of personal HIV status, concern about children and family, and a good health provider relationship were important reasons motivating adherence. Several reminder systems were developed by the participants.
Although a isoniazid preventive therapy programme was shown to be feasible, further adjustments on the selection of participants, enrollment process, and follow-up system based on these findings are necessary to increase the adherence.
确定泰国北部无症状HIV感染者中结核病预防性治疗的依从水平及相关原因。
一项为期9个月随访的前瞻性队列研究。
共有412名HIV感染者参与了一家医院的结核病预防性治疗项目。开具了为期9个月的异烟肼治疗方案。通过清点药片确定依从性。对错过预定预约超过一个月的参与者进行访谈。对成功完成治疗的参与者进行了5次焦点小组讨论。
412名参与者中，69.4%（286人）完成了9个月的治疗方案。依从率定义为服用超过80%药片的人数比例，为67.5%（n = 278）。性别、参与者来源和身体症状史与依从性相关。很大一部分违约发生在治疗开始时。外出迁移、否认HIV感染状态以及异烟肼的感知副作用常被列为不依从的原因。对于那些坚持治疗的参与者，接受个人HIV感染状态、对子女和家庭的关心以及与医疗服务提供者的良好关系是促使他们坚持治疗的重要原因。参与者开发了几种提醒系统。
尽管异烟肼预防性治疗方案被证明是可行的，但基于这些发现，有必要对参与者的选择、入组过程和随访系统进行进一步调整，以提高依从性。
