Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy?
Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy?
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DOI：
10.1186/s12936-015-0602-x
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发表时间：
2015-02-19
期刊：
影响因子：
3
通讯作者：
Goodman C
中科院分区：
文献类型：
--
作者：
Bruxvoort K;Kalolella A;Cairns M;Festo C;Kenani M;Lyaruu P;Kachur SP;Schellenberg D;Goodman C
青蒿素联合疗法（ACT）是大多数疟疾流行国家的一线治疗方法，并且越来越多地在私营部门提供。大多数关于 ACT 依从性的研究都是在公共部门进行的，来自私营零售商的数据很少。在坦桑尼亚进行了平行研究，对在 40 个随机选择的公共卫生机构和 37 个认可的药物配药网点 (ADDO) 获得蒿甲醚-本芴醇 (AL) 的患者进行家中拜访，并询问其服用剂量。使用具有出口随机效应的逻辑回归来评估部门对依从性的影响，控制潜在的混杂因素。在 572 名医疗机构患者和 450 名 ADDO 患者中，分别有 74.5% (95% CI: 69.8, 78.8) 和 69.8% (95% CI: 64.6, 74.5) 完成治疗，46.0% (95% CI: 40.9, 51.2) 和 34.8% (95% CI: 30.1, 39.8）在正确的时间服用每剂药物（“及时完成”）。 ADDO 患者比医疗机构患者更富有、受教育程度更高、年龄更大、在当天晚些时候就医，并且疟疾检测呈阳性的可能性较小。控制患者特征后，ADDO 患者完成治疗和及时完成治疗的调整赔率分别是医疗机构患者的 0.65 (95% CI: 0.43, 1.00) 和 0.69 (95% CI: 0.47, 1.01) 倍。较高的社会经济地位与这两种依从性指标相关。高等教育与完成治疗相关（调整后 OR = 1.68，95% CI：1.20，2.36）；在晚上获得 AL 与及时完成相关（调整后 OR = 0.35，95% CI：0.19，0.64）。分别检查了与每个部门的依从性相关的因素。在这两个领域，回忆正确的指示与这两种遵守措施均呈正相关。在医疗机构患者中，但在 ADDO 患者中，在出口处服用第一剂 AL 与及时完成相关（调整后 OR = 2.11，95% CI：1.46，3.04）。在控制患者特征时，有一些证据表明 ADDO 患者的调整后依从率低于公共卫生机构患者的依从性。需要更好地了解哪些患者护理方面对于依从性最重要，包括有效提供建议的作用。本文的在线版本 (doi:10.1186/s12936-015-0602-x) 包含补充材料，可供授权用户使用。
Artemisinin combination therapy (ACT) is first-line treatment for malaria in most endemic countries and is increasingly available in the private sector. Most studies on ACT adherence have been conducted in the public sector, with minimal data from private retailers. Parallel studies were conducted in Tanzania, in which patients obtaining artemether-lumefantrine (AL) at 40 randomly selected public health facilities and 37 accredited drug dispensing outlets (ADDOs) were visited at home and questioned about doses taken. The effect of sector on adherence, controlling for potential confounders was assessed using logistic regression with a random effect for outlet. Of 572 health facility patients and 450 ADDO patients, 74.5% (95% CI: 69.8, 78.8) and 69.8% (95% CI: 64.6, 74.5), respectively, completed treatment and 46.0% (95% CI: 40.9, 51.2) and 34.8% (95% CI: 30.1, 39.8) took each dose at the correct time (‘timely completion’). ADDO patients were wealthier, more educated, older, sought care later in the day, and were less likely to test positive for malaria than health facility patients. Controlling for patient characteristics, the adjusted odds of completed treatment and of timely completion for ADDO patients were 0.65 (95% CI: 0.43, 1.00) and 0.69 (95% CI: 0.47, 1.01) times that of health facility patients. Higher socio-economic status was associated with both adherence measures. Higher education was associated with completed treatment (adjusted OR = 1.68, 95% CI: 1.20, 2.36); obtaining AL in the evening was associated with timely completion (adjusted OR = 0.35, 95% CI: 0.19, 0.64). Factors associated with adherence in each sector were examined separately. In both sectors, recalling correct instructions was positively associated with both adherence measures. In health facility patients, but not ADDO patients, taking the first dose of AL at the outlet was associated with timely completion (adjusted OR = 2.11, 95% CI: 1.46, 3.04). When controlling for patient characteristics, there was some evidence that the adjusted odds of adherence for ADDO patients was lower than that for public health facility patients. Better understanding is needed of which patient care aspects are most important for adherence, including the role of effective provision of advice. The online version of this article (doi:10.1186/s12936-015-0602-x) contains supplementary material, which is available to authorized users.
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影响因子：
3.7
作者：
Briggs MA;Kalolella A;Bruxvoort K;Wiegand R;Lopez G;Festo C;Lyaruu P;Kenani M;Abdulla S;Goodman C;Kachur SP
通讯作者：
Kachur SP
DOI：
10.1353/cpr.0.0063
发表时间：
2009-01-01
期刊：
Progress in community health partnerships : research, education, and action
影响因子：
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作者：
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通讯作者：
Alphonce, Emmanuel
DOI：
10.4269/ajtmh.14-0126
发表时间：
2014-10
期刊：
The American journal of tropical medicine and hygiene
影响因子：
--
作者：
Bruxvoort K;Festo C;Kalolella A;Cairns M;Lyaruu P;Kenani M;Kachur SP;Goodman C;Schellenberg D
通讯作者：
Schellenberg D
影响因子：
3
作者：
Minzi, Omary;Maige, Sylivester;Ngasala, Billy
通讯作者：
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影响因子：
15.8
作者：
Kangwana, Beth P.;Kedenge, Sarah V.;Goodman, Catherine A.
通讯作者：
Goodman, Catherine A.