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背景:赞比亚一家城市结核病门诊部。目的:确认与中断治疗增加有关的患者特征,尤其是关于接受治疗的相关知识及费用因素。设计:对15岁以上、开始治疗的结核病患者进行前瞻性队列研究,采用半结构式调查表调查及对其后一周三次直接观察下治疗(DOT)就诊情况的观察。结果:301例患者中,共有76例(25.2%)中断了治疗,25例未恢复治疗。中断治疗率较高者为对治疗成功信心不足者(HR3.64;95%CI:1.42-9.31,P=0.007)及因接受治疗有明显的时间和费用限制者(HR2.67;95%CI:1.05-6.81;P=0.04)。在不同治疗阶段这些因素的影响不同,在开始治疗的90天,对治疗成功信心不足的因素影响明显,而因到门诊部接受治疗而增加交通费用的因素则多发生于治疗90天后。结论:在赞比亚,在开始治疗及治疗期间的不同阶段均可发现中断治疗的高危人群。在治疗3个月后,患者对治疗成功信心增强后,可考虑采用以家庭为基础的自我服药,这样可减少患者去门诊部接受治疗的费用。
Background: An urban tuberculosis clinic in Zambia. Purpose: To identify patient characteristics associated with increased discontinuation of treatment, especially regarding the knowledge and costs associated with receiving treatment. DESIGN: A prospective cohort study of tuberculosis patients over 15 years of age who started treatment was conducted using a semi-structured questionnaire survey and observation of treatment visits (DOT) three times a week following the direct observation. Results: Of 301 patients, 76 (25.2%) discontinued treatment and 25 did not resume treatment. Those with high discontinuation rates were those who had less confidence in treatment success (HR 3.64; 95% CI: 1.42-9.31, P = 0.007) and those who had significant time and costs for treatment (HR 2.67; 95% CI : 1.05-6.81; P = 0.04). These factors have different effects at different stages of treatment, with significant effects on the lack of confidence in the success of the treatment 90 days after the start of treatment, and the increase in transport costs due to outpatient treatment most often occurring 90 days after treatment. CONCLUSIONS: In Zambia, high-risk individuals who discontinue treatment may be found at various stages of treatment and treatment. After three months of treatment, the patient’s confidence in the success of the treatment may be considered as a home-based self-medication, which will reduce the cost of the patient going to the clinic for treatment.