WHEN TUBERCULOSIS TREATMENT FAILS - A SOCIAL BEHAVIORAL ACCOUNT OF PATIENT ADHERENCE
WHEN TUBERCULOSIS TREATMENT FAILS - A SOCIAL BEHAVIORAL ACCOUNT OF PATIENT ADHERENCE
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DOI：
10.1164/ajrccm/147.5.1311
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发表时间：
1993-05-01
期刊：
影响因子：
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通讯作者：
SUMARTOJO, E
中科院分区：
文献类型：
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作者：
SUMARTOJO, E
为什么结核病这种可以治疗和治愈的疾病却被证明如此难以消除？事实上，为什么病例数量，特别是耐药病例数量不断增加？几乎无一例外，专家们都承认患者依从性在这一困境中发挥着核心作用，并且他们越来越多地将依从性差视为行为问题。本报告介绍了与结核病治疗和预防相关的患者依从性研究。它总结了与患者是否服用抗结核药物和完成治疗相关的社会和行为因素的文献，并提出了需要对结核病相关行为问题感兴趣的研究人员注意的问题。由于疾病流行病学的变化，此时对患者依从性的行为和社会研究尤为重要。自 20 世纪 80 年代初以来，由于艾滋病毒/艾滋病的出现，美国结核病病例数有所增加 (1)；来自结核病高发国家的大量移民 (2)；不利的社会环境，包括贫困、无家可归和药物滥用 (3, 4)；以及医疗保健基础设施的恶化 (5)。耐药和多重耐药结核菌株已经出现 (6)，这在很大程度上归因于治疗依从性差。依从性研究也很重要，因为它有助于在抗结核药物临床试验中收集更准确的数据。治疗依从性是结核病的一个特殊问题。结核病虽然不是慢性病，但其预防和治疗
Why has tuberculosis, a treatable and curable disease, proved so resistant to elimination? Why, in fact, are the numbers of cases, particularly drug-resistant cases, increasing? Almost without exception, experts acknowledge the central role of patient adherence in this dilemma, and increasingly they identify poor adherence as a behavioral problem. This report provides an account of the research on patient adherence as it relates to the treatment and prevention of tuberculosis. It summarizes the literature on social and behavioral factors that relates to whether patients take antituberculosis medicines and complete treatment, and it suggests issues that require the attention of researchers who are interested in behavioral questions relative to tuberculosis. Behavioral and social research on patient adherence is particularly important at this time because of changes in the epidemiology of the disease. Since the early 1980s, the number of cases of tuberculosis has increased in the United States because of the emergence of HIV/AIDS (1); large numbers of immigrants from countries where tuberculosis rates are high (2); adverse social circumstances including poverty, homelessness, and substance abuse (3, 4); and deterioration of the health-care infrastructure (5). Drug-resistant and multidrug-resistant strains of tuberculosis have emerged (6) and are attributed in large part to poor adherence to treatment. Research on adherence is also important because it should assist in the collection of more accurate data in clinical trials of antituberculosis drugs. Treatment adherence is a particular problem in tuberculosis. Although tuberculosis is not a chronic disease, its prevention and