Development of a Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant Tuberculosis (MDR-TB) Care in Nepal
Development of a Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant Tuberculosis (MDR-TB) Care in Nepal
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DOI：
10.1371/journal.pone.0167559
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发表时间：
2017-01-18
期刊：
影响因子：
3.7
通讯作者：
Newell, James N.
中科院分区：
文献类型：
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作者：
Khanal, Sudeepa;Elsey, Helen;Newell, James N.
耐多药结核病(MDR-TB)对世界各地的公共卫生构成重大威胁，特别是在低收入国家。目前的长期(20个月)和艰苦的治疗方案使用的是具有副作用的强效药物，包括精神疾病。与药物敏感型结核病(TB)相比，它有很高的失访(25%)和更高的病死率和更低的治愈率。虽然一些国家结核病方案向患者提供小额经济补贴，但心理社会健康不良的其他方面，包括医源性疾病，并未得到常规评估或解决。我们的目标是开发一种干预措施，以改善尼泊尔耐多药结核病患者的心理社会福祉。为此，我们对耐多药结核病患者、卫生专业人员和尼泊尔国家结核病规划(NTP)进行了定性工作。我们对15名患者(10名男性和5名女性，年龄21至68岁)、4名家庭成员和3名前线卫生工作者进行了半结构化访谈。此外，还与耐多药结核病患者举行了三次焦点小组会议，并与其家属举行了三次小组讨论。我们与关键利益攸关方举行了一系列会议和研讨会，以设计干预措施，并与NTP密切合作，实现政府所有权。我们的研究结果突出了耐多药结核病治疗对心理健康的负面影响，在社会和财政支持有限的人中感受到的影响更大，主要是已婚妇女。Michie等人(2011)的行为改变框架被证明有助于确定相应的实践和政策层面的改变。这项研究的结果强调了量身定做的心理社会支持的必要性。最近关于普通人群的简单心理支持包的工作可以有益地改编用于耐多药结核病患者。
Multi-drug-resistant tuberculosis (MDR-TB) poses a major threat to public health worldwide, particularly in low-income countries. The current long (20 month) and arduous treatment regime uses powerful drugs with side-effects that include mental ill-health. It has a high loss to-follow-up (25%) and higher case fatality and lower cure-rates than those with drug sensitive tuberculosis (TB). While some national TB programmes provide small financial allowances to patients, other aspects of psychosocial ill-health, including iatrogenic ones, are not routinely assessed or addressed. We aimed to develop an intervention to improve psycho social well-being for MDR-TB patients in Nepal. To do this we conducted qualitative work with MDR-TB patients, health professionals and the National TB programme (NTP) in Nepal. We conducted semi-structured interviews (SSIs) with 15 patients (10 men and 5 women, aged 21 to 68), four family members and three frontline health workers. In addition, three focus groups were held with MDR-TB patients and three with their family members. We conducted a series of meetings and workshops with key stakeholders to design the intervention, working closely with the NTP to enable government ownership. Our findings highlight the negative impacts of MDR-TB treatment on mental health, with greater impacts felt among those with limited social and financial support, predominantly married women. Michie et al's (2011) framework for behaviour change proved helpful in identifying corresponding practice- and policy-level changes. The findings from this study emphasise the need for tailored psycho-social support. Recent work on simple psychological support packages for the general population can usefully be adapted for use with people with MDR-TB.