| ObjectivesTo understand the acceptability and its associated factors of close contacts of PTB and health service providers on the implementation of preventive treatment among latent infected close contacts of PTB and provide a scientific basis for promoting preventive treatment among close contacts of PTB.MethodsThis study was based on "Intervention on Latent Infected close contacts of PTB ".It was a cross-sectional study,selecting 2413 bacteriologically positive PTB patients from Jan.1st,2018 to Jan.15th,2020(1088 cases in the 12-week combination regimen group,1325 cases in the 6-month isoniazid regimen group),whose latently infected close contacts were enrolled(1033 cases in the 12-week combination regimen group,1073 in the 6-month isoniazid regimen group).The main contents of the questionnaire included the social demographic information of the close contacts with latent tuberculosis infection,the awareness of the knowledge of TB control and prevention,the history of TB exposure,the symptoms of the index cases,and whether they were willing to take preventive medicine.The data was entered into the specific system,and was analyzed using SAS 9.4 software.Chi-square test and Trend Chi-square test were used to compare the count data.Based on a case-control study,a questionnaire survey was conducted among 364 contacts who actually took medicine(case)and 195 contacts who refused prophylactic treatment(control),thus to understand the acceptability of preventive treatment and its associated factors among latent infected close contacts(173 cases and 96 controls in the 12-week combination regimen group,191 cases and 99controls in the 6-month isoniazid regimen group).The main content of the questionnaire included demographic information of close contacts,knowledge of tuberculosis prevention and treatment,history of exposure to TB,TB symptoms of their index cases,possible influencing factors of acceptance of preventive treatment,and reasons for rejection of preventive treatment,etc.Epidata 3.1 software was used for data entry,SAS 9.4 software was used for statistical analysis.Acceptability of the close contaxts was analyzed with Chi-square test,Fisher exact test and unconditional dichotomous logistic regression test.In the 15 counties with relatively rapid progression(There had been contacts who had finished the treatment),we choosed a head in management of TB in local health commision,a leader in management of TB in local CDC,a leader in management of TB in local tuberculosis designated hospital,the director and staff in TB department in local CDC,the director and staff in TB clinic to conduct personal in-depth interviews.We also choosed 5 township doctors and 5 village doctors to conduct focus group interviews respectively.The goal was to know more about their attitude and existing problems in the implementation of preventive treatment.The subject frame analysis method is used to analyze and summarize the information obtained.Results1.Acceptance and acceptability of latent infected close contacts on preventive treatmentAmong 1033 cases in 12-week combination regimen group,76.28%(788/1033)were willing to take medicine,and the acceptance rate was 75.02%(775/1033).Among the 1073 cases in 6-month isoniazid regimen group,71.30%(765/1073)were willing to take medicine,and the acceptance rate was 69.52%(746/1073).Acceptance(χ2=6.76,p<0.01)and acceptability(χ2=7.17,p<0.01)of latent infected close contacts in 12-week combination regimen group were both higher than in 6 month isoniazid regimen group.2.Factors affecting acceptability of preventive treatment among latent infected close contactsIn the 12-week combination regimen group,a total of 173 contacts taking medicine and 96 patients refusing medication were investigated.The results showed that protective factors were women(OR=2.16,95%CI:1.07,4.38),aged between 45～60 years old(OR=3.07,95%CI:1.12,8.40)and 60～65 years old(OR=6.35,95%CI:1.47,27.50);The risk factors were that close contacts do not know whether they need to take prophylactic treatment after BCG vaccination(OR=0.16,95%CI:0.04,0.69),worrying about adverse drug reactions(OR=0.27,95%CI:0.12,0.60)and that the time of preventive treatment is too much(OR=0.10,95%CI:0.04,0.25).In the 6-month isoniazid regimen group,a total of 191 contacts taking medicine and 99 contacts refusing medication were investigated.The results showed that protective factors were aged between 45～60 years old(OR=3.57,95%CI:1.17,10.90);The risk factors were that the medical staff did not explain to the close contacts that they had been infected with Mycobacterium tuberculosis(OR=0.36,95%CI:0.13,0.96),medical staff did not explain to close contacts that preventive treatment is for free(OR=0.06,95%CI:0.01,0.34),close contacts didn’t trust doctors in designated hospitals(OR=0.09,95%CI:0.01,0.53),thought that preventive treatment will delay work(OR=0.37,95%CI:0.17,0.79),worrying about adverse drug reactions(OR=0.36,95%CI:0.17,0.75),and considered that the prophylactic treatment period was too long(OR=0.36,95%CI:0.16,0.86).3.Acceptance on preventive treatment for latent infected close contacts among health care providersIn this study,84 in-depth personal interviews and 20 focus group interviews were conducted.The interview found that most health service providers were in favor of carrying out preventive treatment among close contacts of latent tuberculosis,and they were more inclined to choose the 12-week combination regimen.However,there were still many obstacles in carrying out preventive treatment locally,including fund,the attitudes of medical staff,the human resource allocation of tuberculosis management agencies,and the awareness of preventive treatment among close contacts.Conclusions1.Acceptance and acceptability of latent infected close contacts in 12-week combination regimen group were both higher than in 6-month isoniazid regimen group.2.Contacts aged below 15 were more likely to refuse preventive treatment compared with contacts in the group aged 45～60.3.In the 12-week combination regimen group,gender,the necessity of preventive treatment after BCG vaccination,adverse reactions,and the number of preventive treatment medications are influencing factors for the acceptance of preventive treatment.4.In the 6-month isoniazid regimen group,the propaganda and mobilization of medical staff,the trust of close contacts with doctors in designated tuberculosis hospitals,whether preventive work is delayed,adverse reactions,and the length of pretventive treatment courses are factors that affect the acceptance of preventive treatment.5.Most health service providers held positive attitudes to preventive treatment among close contacts of latent tuberculosis,and they were more inclined to choosethe 12-week combination regimen. |
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