Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in southern Ethiopia
Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in southern Ethiopia
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DOI：
10.1371/journal.pmed.0040037
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发表时间：
2007-02-01
期刊：
影响因子：
15.8
通讯作者：
Lindtjorn, Bernt
中科院分区：
文献类型：
--
作者：
Shargie, Estifanos Biru;Lindtjorn, Bernt
背景拖欠治疗仍然是大多数结核病控制方案面临的挑战。它可能会增加耐药性、复发、死亡和长期传染性的风险。本研究的目的是确定影响涂阳肺结核患者治疗依从性的因素。方法和发现前瞻性纳入2002年9月1日至2004年4月30日在埃塞俄比亚南部Hossana医院确诊和登记的涂阳肺结核患者队列。使用结构化问卷，在治疗开始时记录潜在的违约预测因素，并对患者进行跟踪，直到治疗结束。计算违约发生率，并在预先登记的危险因素之间进行比较。在登记接受治疗的404名患者中，81名(20%)未能接受治疗。总共91%(74/81)的治疗中断发生在治疗的持续阶段。在COX回归模型中，从家到治疗中心的距离(风险比[HR]2.97；p<；0.001)，年龄和年龄(HR=1.71；p=0.02)，以及是否需要使用公共交通工具到达治疗中心(HR=1.59；p=0.06)被发现与违约独立相关。结论在本研究背景下，由于治疗未完成而导致的违约很高，主要决定因素似乎是与实际到达治疗中心相关的因素。持续治疗阶段是中断治疗的最关键时期，未来的干预应考虑到这一因素。
BackgroundDefaulting from treatment remains a challenge for most tuberculosis control programmes. It may increase the risk of drug resistance, relapse, death, and prolonged infectiousness. The aim of this study was to determine factors predicting treatment adherence among smear-positive pulmonary tuberculosis patients.Methods and FindingsA cohort of smear-positive tuberculosis patients diagnosed and registered in Hossana Hospital in southern Ethiopia from 1 September 2002 to 30 April 2004 were prospectively included. Using a structured questionnaire, potential predictor factors for defaulting from treatment were recorded at the beginning of treatment, and patients were followed up until the end of treatment. Default incidence rate was calculated and compared among preregistered risk factors. Of the 404 patients registered for treatment, 81 (20%) defaulted from treatment. A total of 91% (74 of 81) of treatment interruptions occurred during the continuation phase of treatment. On a Cox regression model, distance from home to treatment centre (hazard ratio [HR] 2.97; p < 0.001), age > 25 y (HR = 1.71; p = 0.02), and necessity to use public transport to get to a treatment centre (HR = 1.59; p = 0.06) were found to be independently associated with defaulting from treatment.ConclusionsDefaulting due to treatment noncompletion in this study setting is high, and the main determinants appear to be factors related to physical access to a treatment centre. The continuation phase of treatment is the most crucial time for treatment interruption, and future interventions should take this factor into consideration.