Intensive Phase Non-Compliance to Anti Tubercular Treatment in Patients with HIV-TB Coinfection: A Hospital-based Cross-Sectional Study
Intensive Phase Non-Compliance to Anti Tubercular Treatment in Patients with HIV-TB Coinfection: A Hospital-based Cross-Sectional Study
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DOI：
10.1007/s10900-009-9215-z
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发表时间：
2010-10-01
影响因子：
5.9
通讯作者：
Bandyopadhyay, Dipanjan
中科院分区：
文献类型：
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作者：
Sardar, Partha;Jha, Ayan;Bandyopadhyay, Dipanjan
我们旨在研究 111 名 HIV-TB 合并感染患者不遵守强化阶段抗结核治疗 (ATT) 的患病率和决定因素，这些患者前往加尔各答医学院 APEX HIV/AIDS 转诊中心，使用专门设计的半结构化预测试问卷。依从性定义为在强化阶段服用抗结核药物总预定剂量的千分之95%。收集了有关社会人口统计参数、疾病信息、患者知识和治疗障碍的数据。 HIV-TB 合并感染患者中不遵守 ATT 的比例为 40.5%（95% C.I. = 30.5, 50.5）。多变量逻辑回归分析显示，缺乏适当的咨询、缺乏对结核病正确传播途径的了解、在 ATT 期间拜访庸医以及一旦患者开始感觉好转就急于离开治疗是不依从的重要决定因素。 “无咨询”使不遵守规定的机会（调整后的 OR）增加了 47.12 倍（95% C.I. = 7.99, 195.27）；从而成为对结果影响最大的单一变量。本研究发现，HIV-TB 合并感染患者中不遵守 ATT 的比例高得惊人。结果清楚地表明，迫切需要针对这种合并感染提供充分的咨询和依从性的重要性，以及 DOTS 计划更好的患者友好型导向。 TB-HIV 合作活动对于确保合并感染患者更好地遵守 ATT 依从性至关重要。
We aimed to study the prevalence and determinants of non compliance to intensive phase anti tubercular treatment (ATT) in 111 HIV-TB coinfection patients, attending the APEX Referral Center for HIV/AIDS at Medical College, Kolkata with a specially-designed, semi-structured, pre-tested questionnaire. Compliance was defined as taking a parts per thousand yen95% of the total scheduled doses of anti-TB medicines during the intensive phase. Data was collected on socio-demographic parameters, disease information, patient's knowledge and barriers to treatment. The prevalence of non-compliance to ATT in HIV-TB coinfection patients was found to be 40.5% (95% C.I. = 30.5, 50.5). Multivariate logistic regression analysis showed that absence of proper counseling, lack of knowledge about correct route of TB transmission, visiting quacks during ATT and the urge to leave treatment once patient started feeling better were the significant determinants of non-compliance. "No Counseling" increased chances of non- compliance (adjusted O.R.) 47.12 times (95% C.I. = 7.99, 195.27); thereby being the single most influential variable towards the outcome. The present study finds an alarmingly high prevalence of non-compliance to ATT among HIV-TB coinfection patients. The results clearly indicate that adequate counseling about this coinfection and the importance of compliance, along with better patient-friendly orientation of DOTS programme is urgently needed. Collaborative TB-HIV activities are essential to ensure better ATT compliance in coinfection patients.