| Objective:The aim of this study was to investigate the knowledge of medical tuberculosis workers about the screening and monitoring of hepatitis virus infections in tuberculosis patients.This study would provide a reference for treatment plans to tuberculosis patients who co-infected with hepatitis virus and for reducing drug-induced liver injury.Methods:This study is divided into two parts.Part1:A questionnaire survey was conducted in tertiary and secondary comprehensive hospitals of 16 autonomous prefectures and cities in Yunnan Province in 2018.The participants should involve in the diagnosis and treatment of tuberculosis,and their decisions on screening and monitoring serum biomarkers of HBV and HCV before anti-tuberculosis and glucocorticoid treatment were collected.Part2:An electronic questionnaire was sent to medical tuberculosis workers in 31 provincial regions of China.This assessed the respondents' knowledge of screening and monitoring procedures for HBV and HCV infections in TB patients.The worker's demographics and level of experience in TB management,together with the availability of hepatitis screening tests in their hospital was also assessed.Results:Part1:A survey was carried out in Yunnan province,a total of 1000 questionnaires were sent out,and 942 questionnaires were returned.After 52 invalid questionnaires were excluded,890 questionnaires were finally valid,which came from 21 tertiary hospitals and 64 secondary hospitals.The proportion of medical workers deciding to screen anti-HCV(48.8%,434/890)was significantly lower than that of deciding to screen HBsAg(70.7%,629/890,P<0.001,?2=88.805)before anti-tuberculosis treatment.The proportion of medical workers who decided to screen anti-HCV(72.1%,642/890)was also lower than that for HBsAg screening(75.6%,673/890)before the use of glucocorticoid treatment,although the overall difference was not significant(P=0.094,?2=2.794).Binary logistic regression multivariate analysis showed that the department category and professional title were independent predictors for medical workers screen anti-HCV before glucocorticoid treatment.The knowledge of decision on screening anti-HCV were relatively higher among the medical workers in the department of infectious diseases(OR1.834,95%CI 1.342-2.505,P=0.001),the senior title(OR1.745,95%CI 1.115-2.731,P=0.015).Hospital level,department category and professional title were independent predictors for medical workers screen HBsAg before glucocorticoid treatment,The knowledge of decision on screening HBsAg were relatively higher among the medical workers in tertiary hospital(OR 1.735,95%CI 1.223-2.441,P=0.002),in the department of infectious diseases(OR 1.567,95%CI 1.133-2.167,P=0.007)and the senior title(OR 1.786,95%CI 1.104-2.888,P=0.018).During glucocorticoid use,both hospital level and department category were independent predictors for medical workers to monitor HCV RNA,The knowledge of decision on monitoring HCV RNA were relatively higher among the medical workers in tertiary hospital(OR 1.898,95%CI 1.285-2.802,P=0.001),in the department of infectious diseases(OR 2.039,95%CI 1.391-2.988,P<0.001)and hospital level,department category and professional title were independent predictors for medical workers to monitor HBV DNA.The knowledge of decision on monitoring HBV DNA were relatively higher among the medical workers in tertiary hospital(OR 2.019,95%CI 1.385-2.943,P<0.001),in the department of infectious diseases(OR 2.269,95%CI 1.573-3.275,P<0.001)and the senior title(OR2.435,95%CI 1.373-4.320,P=0.002).Part2:In a nationwide survey,a total of 2507 questionnaires were collected from 22 provinces,4 municipalities and 5 autonomous regions.After 352 invalid questionnaires were excluded,2155 questionnaires were finally valid.The range of total knowledge scores for each physician varied from 0 to 8,and a score of less than 5 occurred in 21.1%of respondents,especially in the western provinces,secondary hospitals and non-infectious disease departments.The proportion of medical workers who screened for anti-HCV before initiating anti-tuberculosis treatment was significantly lower than the proportion either screening for HBsAg(52.8%vs.71.1%,P<0.001)or asking about current glucocorticoid treatment(72.7%vs.84.5%,P<0.001).The frequency HCV RNA monitoring was also significantly lower than the frequency of HBV DNA monitoring during glucocorticoid treatment(78.1%vs.86.4%,P<0.001).The HCV RNA test and HBV DNA test was available to a higher percentage of respondents in tertiary hospitals and non-western provinces than in secondary hospitals and western provinces.Binary logistic regression analysis showed that the frequency with which a medical worker monitored for hepatitis virus infection in TB patients was associated with their hospital department,the hospital's level and location in China and the availability of appropriate laboratory support.Conclusion:Our findings indicate that there is substantial between-worker variation in the knowledge and practice of screening and monitoring of hepatitis virus infections in TB patients in China.This suggests that increased training of medical workers and increased availability of laboratory testing for these infections would reduce serious liver injury among TB patients. |
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