| Drug abuse has become an increasing serious social problem woeldwde. In the early 1980s, drug abuse emerged again and by the end of 2005, the accumulative number of registered drug abusers in China is up to 1160,000. However, it was estimated that the actual number of drug abusers in China was up to 7 million. Presently, heroin is still the main type of drugs in the market and the total nember of heroin abusers is 0.7 million which is 78.3% of all drug abusers. Drug abuse can have negatively effects on individual's health, country's economy, social stability and also bring about serious public helath problems. A detoxification system largely on compulsory detoxification has been developed. Abutting to "Golgen Triangle", Yunnan and Sichuan provinces have become the most serious areas of drug abusing.Tuberculosis is still one of the severe infectious deseases all over the world. With the epidemic of HIV/AIDS and increase of anti-TB drug-resistance, the total number of TB patients is increasing. As one of 22 countries with high-burden of TB worldwide, China has a serious epidemic of TB. DOTS Strategy recommended by WHO has become the most effective measure for controlling TB.Drug abusers are at high risk of tuberculous infection and disease through the overlap of homelessness, human immunodeficiency virus (HIV) infection, low socioeconomic status, and incomplete adherence to tuberculosis therapy. It was reported that TB prevalence rate in drug abusers in China was 6 to 8 times higher than that of non-drug abuse population and the TB prevalence is at the interval of 1.33%～9.6%. Systematic research on TB in drug abusers has not been found in domestic literatures and although there are a few similar researches abroad, the differences of detoxifcation system and TB control system are large. This study is to explore how drug abuse effecting TB prevalence, prevention, treatment and control for drug abusers, and to identify factors influencing access to TB services for drug abusers.MethodsQualitative and quantitative methods were used to analyze the utiliztion of TB care in drug abusers. Considering marginalization and accessibility to drug abusers, two reeducation institutions through labor in Yunnan and Sichuan provinces were purposively selected respectively as study sites. Data sources included literature and documents review, financial and activity records review, patient-based survey and focus group discussion, and key informant interview of government officials, and TB specialties. In key informant interviews, a total of 14 officials, directors of hospitals and TB control stations and tuberculosis specialties were selected. In patient-based study, a total of 147 TB patients were selected in the two reeducation institutions. Data were collected by faculty staff member and graduate students from Shandong University and Sichuan University considering the local dialects of study sites.Content analysis was used for analyzing the data of policy documents, key informants interview and focus group discussion to identify the determinants of TB service utilization for drug abusers. Case study was used for explore the utilization of TB care for drug abusers.ResultsDirect policies and regulations on TB control for drug abusers were less and Regulations on TB Control and Prevention in Labor Institution in China enacted by Ministry of Justice and Ministry of Health is the only one directly for TB control in drug abusers so far. However, the gap between the implementation and regulations is large.The prevalence rate of active tuberculosis in reeducation institutions of Yunan and Sichan provinces is much higher than that of general population and this is in line with other domestic and abroad studies. The findings show that TB prevalence in drug abusers of Yi race is much higher than that of Han race.Compared with social TB control institutions, the ability to TB control in incarceration is not stronger. As a complete unit, the ability to TB control in reeducation institutions through labor is much better than compulsory detoxification institution. As for reeducation institutions through labor, the ability to TB control of provincial level is better than that of municipal level. Basically, the quantity of medical workers in reeducation institutions through labor can meet the preventive and curable needs. However, there were no full-time health workers for TB control in the two sampled institutions. Meanwhile, reeducation institutions could be financed by a package of government budget which is 96 Yuan per year per drug abuser including prevention and treatment of infectious and non-communicable diseases. The ability to TB control at all levels of social TB control stations has become stonger.However, sputum testing can not be provided for most of reeducation institutions in China. In recent three years, almost all patients found in Dali reeducation institution have been paroled for TB services outside and 60.5% TB patients had been paroled in Sha-ping reeducation institution with medical restrictions. The main way to detect new TB cases in drug abusers for social TB control stations is that TB screening is often conducted in drug abusers with HIV-positive. However, a trend of unwillingness of providing TB care for drug abusers has occurred because the lower adherence of this marginalized population will affect TB curing rate and funds from TB projects may be cut down accordingly. However, the collaboration between reeducation institutions and public health sector was weak. And basically, the cooperation is much better at provincial levels.The utilization of TB care in drug abusers has double characteristics. There exists systematization and no self-determination in incarceration. However, TB patients in drug abusers can select the medical institutions outside incarceration. Utilization of TB health care of 147 sampled TB patients in this study, 74 drug abusers had TB care experience in reeducation institutions, and 70 were detected for appearance of symptoms, and 3 for physical examination, and 1 for the other disease. 56% (41/70) went to hospitals within two weeks after symptoms were felt. Meanwhile, 81.1% (60/74) had been treated inside and 22% (12/60) discontinued taking medicine in the process of treatment. In this study, 46.3% (68/147) had TB care seeking experiences outside reeducation institutions and compulsory detoxification institutions. About 41% (28/68) went to see health providers within two weeks after symptoms were felt. The average delayed period in society is 37 days and 20 days in reeducation institutions which is longer than that of general population.Discontinuity of TB treatment seldom occurs in reeducation institutions for compulsory treatment unless severe side-effects. However, the discontinuity in society is serious. 82% (55/67) discontinued the treatment for TB, and 40% (22/55) were for drug abuse again. 76% (52/68) continued drug abusing in the process of TB diagnosis and treatment. In Principle, the TB care for drug abusers in reeducation institutions is free of charge. However, some items such as liver-protective medicines should be purchased. The findings indicate that the average expenditure of tuberculosis per patient was 2769 Yuan in society and it is much higher than that of general population.In this study, the influencing factors for TB care of drug abusers can be divided into two types. The first concerns drug abusers such as indifference of health, lack of TB knowledge, less surport of families and society and so forth. Additionally, it concerns activities and psychology of drug abuse such as the similarity of symptoms caused by drug abuse and TB, decline of immunity, shame and sin for drug abuse, thirst for drugs, abirritation of drug abuse and so on. Second involves other uncontrollable factors by drug abusers such as the provision of TB care, the laws and policies for TB control in drug abusers, HIV- TB double infections and so forth.Conclusions and RecommendationsTB epidemic burden is much higher in drug abusers than that of general population and there exists difference among races in TB pravelence. There were less specific policies for TB control for drug abusers. The collaboration mechanism between social TB control stations and reeducation institutions are weak. Financial capabilities of governments at all levels are crucial for TB control in drug abusers in reeducation institutions. The utilization of TB care inside and outside reeducation institutions are insufficient, however, it is better inside reeducation institutions than that of outside. The major influencing factors for TB services in drug abusers included less TB knowledge and social support, drug abuse, insufficient provision, HIV-TB double infections and lower adherence, etc. The recommendations are as follows: Firstly, the standard of medical outlay and TB control and prevetion should be enhanced to purchase or update equipments. Secondly, the collaboration mechanism between social TB control stations and reeducation institutions should be strengthened. Thirdly, to explore a suitable TB health education method for drug abusers. Finally, to lower the evaluation standard of TB program for drug abusers.
|
PDF Full Text Request