The Intervention Study Of The Treatment Adherence For TB Cases In Poor Mountainous Areas

Background:China is one of the22TB high-bueden countries in the world,thenumber of TB patients in second place.At the same time, MDR-TB epidemic in china isvery serious,is one of the27drug-resistant TB high-burden countries, the numberofmultidrug-resistant patients in second place. Detection and cure of TB patients is the mosteffective measures to control the TB epidemic, one of the key factors that affect the curerate is whether the patient follow-up review on a regular basis and take medicine on time.Since TB is a chronic infectious disease, the course of treatment is longer, TB patients oftendo not adhere to treatment.The geographical environment mainly is mountainous areas inChongqing, especialy in remote moutainous of the vast rural areas, due to the inconvenienttranportation, economic difficulties and other reasons, the treatment adherence of TBpatients is poor, can not review and get medicine on time. This study investigate theinfluencing factors of the treatment adherence of new smear positive TB patients in poorarease and carry out the intervention study of treatment adherence to research and evaluatethe work systematically.Objective：Analyze the treatment adherence of TB patients in poor mountainous areasand its main inliuencing factors, and provide a scientific basis to improve the treatmentadherence of TB patients in poor mountainous areas.Carry out the intervention study oftreatment adherence through distributing the transport subsidies to TB patients in poormountainous areas in the support of the first round of global fund TB project, evaluate theeffect of implementation of distributing the transport subsidies to provide a basis for ourcountry to develop relevant policies.Methods：Selected WX County which is state-level poor county in ChongqingMunicipality, as the implementation of county and collected the basic information of TBpatients registered in anti-TB institution at county level,carrried out the qualitative interviews with key figures, analyzed the treatment adherence of TB patients in poormountainous areas and its influencing factors. In the county,200new smear-positive TBcases were selected continuously and offered transport subsidies, evaluated the effect of theimplementation by comparing the sputum examination, taking medicine on time, andtreatment outcomes, etc before and after the intervention in the region.Results:379cases of new smear positive TB were registered in WX anti-TBinstitution. During the follow-up period,302cases reviewed on time, the review rate was79.7%. The phenomenon of failure to review have occurred at the end of second and fifth,sixth month of treatment, but mainiy at the end of second month, and have the statisticaldifference comparing the review adherence at the end of fifth and sixth month of treatment.There have statistical correlation between the review adherence and age, distance from theliving place to anti-TB institution, the transport costs, with a negative correlation. Thequalitative research also found that patients with financial difficulties, patients with poorTB knowledge, the patients, living away from the anti-TB institution is so far, are the mainfactors to affect the review adherence of patients.Before and after intervention of subject, the regular sputum examining rate and thesputum bacteria negative transferring rate of cases at the end of second month of treatmentwas increased by71.9%to96.0%,59.0%to88.5%respectively, the regular sputumexamining rate at the end of fifth month of treatment was increased by95.9%to98.5%, therate of taking medicine was increased by65.4%to99.5%, The above data had significantdifference. This suggests that it is help to improve the ratio of sputum examining and getthe medicine on time that distribute transport subsidies for TB cases.The sputum bacterianegative transferring rate at the end of fifth month of treatment was increased by95.9%to96.0%, the regular sputum examining rate at the end of sixth month of treatment wasdecreased by97.2%to96.0%, the sputum bacteria negative transferring rate at the end ofsixth month of treatment was decreased by96.8%to96.0%, and the cure rate wasdecreased by96.8%to96.0%, the treatment success rate was decreased by99.0%to97.0%.The above data had no significant difference. This suggests that there is no significantinfluence to the review adherence of TB patients in the late treatment that distributetransport subsidies for TB cases.The qualitative study found that distributing transportsubsidies for TB cases is helpful to review adherence, but the subsidy is too low. Distributing transport subsidies not only reduce the economic burden, but also strengthenthe awareness of proactive review.Conclusion：The review adherence of TB patients is poor in poor mountainous areas,occurs mainly at the end of second month, which suggesting that TB control staff shouldpay attention to the emphasis period of first two months.The influencing factors of reviewadherence are age, distance from the living place to anti-TB institution, the transport costs.It is help to improve the ratio of sputum examining and get the medicine on time thatdistribute transport subsidies for TB cases,and the sputum conversion rate of the end ofsecond month of treatment is also increased, but its need to improvement further in thescope of issuance of transport costs, payment amount and payment mode. In oder to reallyensure that the patient take medication regularly and achieve the purpose of cure, it requirescomprehensive implementation of other measures.