| ObjectivesWe aimes to investigate the status of treatment adherence and management of multidrug-resistant tuberculosis(MDR-TB)patients in Chongqing,to analyze influencing factors for adherence and management of MDR-TB patients,and to provide evidences for improving the management of MDR-TB patients’ treatment,aherence and MDR-TB prevention in Chongqing.MethodsMixed research methods(quantitative and qualitative research methods)were conducted to investigate MDR-TB patients,TB healthcare workers(HCWs)from Primary healthcare(PHC)sectors and designated TB hospital in 27 districts/counties in Chongqing.1.Quantitative Study132 patients with MDR-TB were enrolled as the participants of quantitative research.Self-complied questionnaire was used to investigate the status of treatment,adherence behavriorsand management of patients.Data were collected and analyzed using Epidata3.1and SPSS22.0 software.2.Qualitative researchPurposive sampling was used to select two MDR-TB patients with poor adherence during the treatment period as the participants,two TB HCWs from two designated TB hospitals and two TB HCWs from Primary healthcare(PHC)sectors,respectively.Semi-structured interview for in-depth interviews was used to explore the patient’s illness,treatment,and management from HCWs and TB patients.Data were analyzed,sorted,classified and summarized using Thematic Framework Analysis.Results1.Demographic information for participantsMost of enrolled MDR-TB patients were male,rural,low-educated and low-income groups,with 63.6% males and 85.6% low-educated patients,57.6% of the patients lived in rural areas.38.7% were farmers or migrant workers,and 18.2% had permanent income.99.2% Patients have health insurance.70.5% of the patients borrowed money and 10.6% of the patients sold assets after illness,the economic burden of MDR-TB patients is heavy.2.Treatment status of MDR-TB patients97.0% of MDR-TB patients received standard treatment,89.0% and 79.5% of those received outpatient and in-patient treatment respectively,and 75.8% of those received post-discharge injection treatment.81.0% of the patients had side effects during treatment.For those who had not received treatment when survey conducted,52.1% had either been cured or completed the course.17.4% Patients stopped drug use due to financial difficulties and side effects respectively.Doctors in designated hospitals also reported that middle-aged and elderly patients are prone to complications,resulting in difficult treatment and poor medical accessibility.3.Treatment adherence of MDR-TB patientsThere were 42.2%,21.9%,7.8% and 20.3% of MDR-TB patients missed drug intake,interrupted treatment,self-reduced dosage and missed follow-up sputum-exam,respectively.Side effects and forgetting are the main reasons of poor treatment adherence.The results showed that the migrants were more likely to self-reduced dosage than the residents(OR=15.31,95%CI:1.54-152.23).Fewer patients under supervision had self-reduced dosage than patients without supervision(OR=0.22,95%CI:0.05-0.99).Married patients were more likely to missed drug intake(OR=0.29,95%CI:0.11-0.73).Patients under the supervision of primary doctors were more likely to had interrupted treatment(OR=3.84,95%CI:1.05-14.09).Female patients were more likely to had missed follow-up sputum-exam than male patients(OR=2.70,95%CI:1.09-6.65).Medical providers all reported that most patients had bad adherence behaviors.Both medical staff and MDR-TB patients indicated that severe adverse drug reactions and heavy financial burden were the main reasons for the interrupted treatment.4.Supervision and management of MDR-TB patients44.5% of the patients were infromed by doctors in designated hospitals to receive supervision and management by HCWs in primary health sectors after discharge.13.3% of the patients did not receive any supervision and management from the medical institution.72.1% of the patients received supervision and management from primary health sectors at least once,mainly with home visits and telephone supervision.Less than 50% of patients reported receiving health education from doctors in primary health sector/ center for disease control and prevention(CDC)/drug resistant designated hospital.The study indicated that patients with 3 to 30 days treatment delay were less likely to receive doctor’s supervision and management than patients with <3 days treatment delay(OR=0.136,95%CI:0.023-0.795).Patients who were not informed to receive supervision and management of primary health sectors by the doctors from drug resistance designated hospital were less likely to receive supervision and management of doctors(OR=0.169,95%CI:0.031-0.913).Female patients were less likely to receive supervision and management from primary doctors(OR=0.188,95%CI:0.071-0.496).Patients from other districts and counties received less supervision and management from doctors in primary health sector than patients from pengshui county(OR=0.120,95%CI:0.023-0.633).Patients without debt experience were less likely to receive management from doctors in CDC(OR=0.283,95%CI: 0.114-0.707)and doctors in designated hospitals(OR=0.275,95%CI:0.110-0.688).Patients from other districts and counties were more likely to receive supervision and management by doctors in CDC than those from pengshui county(OR=9.020,95%CI:2.392-34.010).Patients who have not been hospitalized were less likely to receive supervision and management from doctors in designated hospitals(OR=0.231,95%CI:0.074-0.719).Interviews disclosed that TB HCWs from PHC sectors believed that most patients were cooperative with supervision and management,but some patients,especially young patients and students were concerned about their privacy being exposed,were unwilling to receive management by HCWs from PHC sectors.HCWs believed that in the current "integrated" TB control system,communication between CDC,PHC sectors and designated TB hospital was lack,and there was no information system for TB pagient management,which did affect delivery of MDR-TB patient management.Conclusions1.The prevention and control of MDR-TB in Chongqing deserve more attention,especially the MDR-TB prevention and control of the vulnerable groups;2.The treatment of MDR-TB patients in Chongqing needs to be further improved,injection treatment is not standardized,and the treatment adherence of patients needs to be improved urgently;3.The management of MDR-TB patients in Chongqing needs to be improved,the standardized management rate needs to be improved,and the patient-centered community patient management model and information system for TB patient management need to be further researched.4.Suggestions: It is suggested to increase investment in the prevention and treatment of MDR-TB in Chongqing;based on internet technology to improve patient-centered community patient management and adherence,build up government leading and multi-sectoral collaboration TB control system. |
PDF Full Text Request