'Something so hard': a mixed-methods study of home sputum collection for tuberculosis contact investigation in Uganda
'Something so hard': a mixed-methods study of home sputum collection for tuberculosis contact investigation in Uganda
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DOI：
10.5588/ijtld.18.0129
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发表时间：
2018-10-01
影响因子：
4
通讯作者：
Davis, J. L.
中科院分区：
文献类型：
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作者：
Armstrong-Hough, M.;Ggita, J.;Davis, J. L.
背景：家庭痰液采集有助于对活动性结核病患者的接触者进行结核病（TB）的及时评估和诊断。我们分析了家庭采集痰液的障碍，作为乌干达坎帕拉家庭结核病接触者调查强化干预措施的一部分。设计：我们进行了一项聚合混合方法研究，描述 91 名接触者的家庭痰液采集结果，并通过 19 次嵌套接触者访谈和与非专业卫生工作者 (LHW) 的两次焦点小组讨论来检查他们的背景。结果：LHW 收集了 35 名接触者 (39%) 的痰液。与有其他症状或危险因素的接触者相比，报告咳嗽的接触者更有可能产生痰（53% vs. 15%，RR 3.6，95% CI 1.5-2.8，P < 0.001）。男性比女性更有可能提供痰液（54% vs. 32%，RR 1.7，95% CI 1.0-2.8，P = 0.05）。联系人表示，指示患者的支持和家访的便利为收集提供了便利。缺少容器和难以自发产生痰液阻碍了收集。女性将耻辱视为障碍。 LHW 强调了获取痰液的困难以及按压接触器产生痰液的不适。结论：LHW 家庭痰液采集面临着与临床环境中痰液采集不同的挑战。需要更多的研究来制定干预措施，以减轻耻辱并提高家庭收集的成功率。
BACKGROUND: Home sputum collection could facilitate prompt evaluation and diagnosis of tuberculosis (TB) among contacts of patients with active TB. We analyzed barriers to home-based collection as part of an enhanced intervention for household TB contact investigation in Kampala, Uganda.DESIGN: We conducted a convergent mixed-methods study to describe the outcomes of home sputum collection in 91 contacts and examine their context through 19 nested contact interviews and two focus group discussions with lay health workers (LHWs).RESULTS: LHWs collected sputum from 35 (39%) contacts. Contacts reporting cough were more likely to provide sputum than those with other symptoms or risk factors (53% vs. 15%, RR 3.6, 95%CI 1.5-2.8, P < 0.001). Males were more likely than females to provide sputum (54% vs. 32%, RR 1.7, 95%CI 1.0-2.8, P = 0.05). Contacts said support from the index patient and the convenience of the home visit facilitated collection. Missing containers and difficulty producing sputum spontaneously impeded collection. Women identified stigma as a barrier. LHWs emphasized difficulty in procuring sputum and discomfort pressing contacts to produce sputum.CONCLUSIONS: Home sputum collection by LHWs entails different challenges from sputum collection in clinical settings. More research is needed to develop interventions to mitigate stigma and increase success of home-based collection.