EFFECTIVENESS OF HOME-BASED DIRECTLY OBSERVED TREATMENT FOR TUBERCULOSIS IN KWENENG WEST SUBDISTRICT, BOTSWANA
EFFECTIVENESS OF HOME-BASED DIRECTLY OBSERVED TREATMENT FOR TUBERCULOSIS IN KWENENG WEST SUBDISTRICT, BOTSWANA
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DOI：
10.4102/phcfm.v2i1.168
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发表时间：
2010-01-01
影响因子：
2
通讯作者：
Mash, Bob
中科院分区：
文献类型：
--
作者：
Kabongo, Diulu;Mash, Bob
背景：结核病和艾滋病毒是博茨瓦纳的主要公共卫生问题。面对日益增长的结核病发病率、低治愈率、人力资源限制和卫生设施的可获得性，博茨瓦纳卫生部决定使用社区志愿者提供家庭直接监督治疗(DOT)。目的：本研究的目的是评估博茨瓦纳夸能西区家庭直接监督治疗(HB-DOT)与基于设施的直接监督治疗(FB-DOT)的结果，并探讨结核病患者、社区志愿者和卫生工作者对HB-DOT的可接受性。采用常规收集的405例肺结核患者资料进行观察性研究，并结合20次定性深度访谈。结果：涂阳肺结核患者总治愈率为78.5%。FB-DOT和HB-DOT的治疗结果没有统计学差异。接触者追踪在FB-DOT患者中明显更好。面谈揭示了FB和HB两种选择的优点和缺点，选择或混合选择的灵活性很重要。受访者提出了一些改进HB-DOT计划的建议。结论：HB-DOT在治疗效果上至少与FB-DOT一样好，但必须注意接触者追踪。HB-DOT为一些患者提供了坚持结核病治疗所需的灵活性，社区志愿者可能会通过持续的培训和卫生工作者的支持、财政奖励和提供基本设备来加强。
Background: Tuberculosis (TB) and HIV are major public health problems in Botswana. In the face of growing TB notification rates, a low cure rate, human resource constraints and poor accessibility to health facilities, Botswana Ministry of Health decided to offer home-based directly observed treatment (DOT) using community volunteers.Objectives: The aim of this study was to assess the outcomes of home-based directly observed treatment (HB-DOT) versus facility-based, directly observed treatment (FB-DOT) in the Kweneng West subdistrict in Botswana and to explore the acceptability of HB-DOT among TB patients, community volunteers and health workers.Method: A quantitative, observational study using routinely collected TB data from 405 TB patients was conducted and combined with 20 qualitative in-depth interviews.Results: The overall cure rate for smear-positive pulmonary TB patients was 78.5%. Treatment outcomes were not statistically different between FB-DOT and HB-DOT. Contact tracing was significantly better in FB-DOT patients. Interviews revealed advantages and disadvantages for both FB and HB options and that flexibility in the choice or mix of options was important. A number of suggestions were made by the interviewees to improve the HB-DOT programme.Conclusion: HB-DOT is at least as good as FB-DOT in terms of the treatment outcomes, but attention must be given to contact tracing. HB-DOT offers some patients the flexibility they need to adhere to TB treatment and community volunteers may be strengthened by ongoing training and support from health workers, financial incentives and provision of basic equipment.