Risk factors associated with default among new smear positive TB patients treated under DOTS in India.
Risk factors associated with default among new smear positive TB patients treated under DOTS in India.
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DOI：
10.1371/journal.pone.0010043
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发表时间：
2010-04-06
期刊：
影响因子：
3.7
通讯作者：
Rao SG
中科院分区：
文献类型：
--
作者：
Vijay S;Kumar P;Chauhan LS;Vollepore BH;Kizhakkethil UP;Rao SG
治疗依从性差，导致耐药性、治疗失败、复发、死亡和持续感染的风险，仍然是结核病控制规划的障碍。该研究的目的是确定登记接受治疗的新涂阳结核病患者的默认预测因素，以提出可能的干预措施，纠正问题，以维持和提高规划的绩效。考虑到该地区的地理、社会文化和人口结构，从6个州选出的20个地区被划分为6个阶层。2004年第三季度至2005年第三季度连续两个季度登记接受治疗的新涂片阳性患者构成回顾性研究队列。病例对照分析包括默认患者为“病例”和相同数量的年龄和性别匹配的完成治疗的患者为“对照组”。通过单变量和多变量逻辑回归分析，计算默认因素和决定因素之间的存在和关联程度。数据收集是通过使用预先测试的半结构化问卷和审查治疗相关记录的患者访谈。获得了广泛的社会人口和患者相关因素的信息。在完成组的687名未完成和人数相等的患者中，分别有389名和540名患者接受了满意的访谈。在logistic回归分析中，与违约独立相关的因素是酗酒[AOR-1.72(1.23-2.44)]、文盲[AOR-1.40(1.03-1.92)]、治疗期间有其他承诺[AOR-3.22(1.1-9.09)]、对结核病的认识不足[AOR-1.88(1.35-2.63)]、医患互动不良[AOR-1.72(1.23-2.44)]、缺乏卫生人员的支持[AOR-1.93(1.41-2.64)]、漏服剂量[AOR-2.56(1.82-3.57)]、对抗结核药物的不良反应[AOR-2.55(1.87-3.47)]和对所提供服务的不满意度[AOR-1.73(1.14-2.6)]。违约的大多数风险因素是面向治疗和提供者的，可以通过适当的干预加以纠正，这将有助于维持良好的方案绩效。
Poor treatment adherence leading to risk of drug resistance, treatment failure, relapse, death and persistent infectiousness remains an impediment to the tuberculosis control programmes. The objective of the study was to identify predictors of default among new smear positive TB patients registered for treatment to suggest possible interventions to set right the problems to sustain and enhance the programme performance. Twenty districts selected from six states were assigned to six strata formed, considering the geographic, socio-cultural and demographic setup of the area. New smear positive patients registered for treatment in two consecutive quarters during III quarter 2004 to III quarter 2005 formed the retrospective study cohort. Case control analysis was done including defaulted patients as “cases” and equal number of age and sex matched patients completing treatment as “controls”. The presence and degree of association between default and determinant factors was computed through univariate and multivariate logistic regression analysis. Data collection was through patient interviews using pre-tested semi structured questionnaire and review of treatment related records. Information on a wide range of socio demographic and patient related factors was obtained. Among the 687 defaulted and equal numbers of patients in completed group, 389 and 540 patients respectively were satisfactorily interviewed. In the logistic regression analysis, factors independently associated with default were alcoholism [AOR-1.72 (1.23–2.44)], illiteracy [AOR-1.40 (1.03–1.92)], having other commitments during treatment [AOR-3.22 (1.1–9.09)], inadequate knowledge of TB [AOR-1.88(1.35–2.63)], poor patient provider interaction [AOR-1.72(1.23–2.44)], lack of support from health staff [AOR-1.93(1.41–2.64)], having instances of missed doses [AOR-2.56(1.82–3.57)], side effects to anti TB drugs [AOR-2.55 (1.87–3.47)] and dissatisfaction with services provided [AOR-1.73 (1.14–2.6)]. Majority of risk factors for default were treatment and provider oriented and rectifiable with appropriate interventions, which would help in sustaining the good programme performance.