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背景:六个俄罗斯地区的结核病服务机构实施的结核病(TB)患者社会支持项目。目的:检出病人不依从治疗的危险因素并评价社会支持的可能影响。方法:回顾研究2003年2～3季度期间登记的涂片阳性和阴性的新结核病人。通过病例——对照研究,包括不依从治疗病人作为病例组、成功治疗病人作为对照组进行的资料分析,采用多变量logistic回归模型分析。结果:共纳入1805例肺结核(PTB)病人。病人不依从治疗的概率为2.3%-6.3%。经多变量分析,不依从治疗的独立相关危险因素有:失业(OR=4.44;95%CI:2.23-8.86),酗酒(OR=1.99;95%CI: 1.04-3.81),无家可归(OR=3.49;95%CI:1.25-9.77)。社会支持降低了不依从结果(OR=0.13;95%CI:0.06-0.28)。该分析控制了年龄、性别、地区、居住地和痰涂片抗酸染色因素的影响。结论:失业、酗酒和无家可归是增加新结核病患者不依从治疗风险的相关因素,相反,社会支持降低了不依从。在俄罗斯为了评估和确定最佳成本——效益的社会支持对改善结核病人治疗结果的作用进一步进行前瞻性随机研究是必须的,尤其在有较高不依从治疗风险的人群。
Background: Social support programs for tuberculosis (TB) patients implemented by six TB service providers in Russia. PURPOSE: To detect the risk factors for noncompliance and evaluate the possible impact of social support. METHODS: A retrospective review of smear-positive and -negative new TB patients registered during the second to third quarters of 2003 was conducted. Multivariate logistic regression models were used to analyze data from case-control studies, including non-adherence patients as case groups, and as successful treatment patients as control groups. Results: A total of 1805 patients with pulmonary tuberculosis (PTB) were enrolled. The probability of patients not following treatment was 2.3% -6.3%. Multivariate analysis showed that the independent risk factors for non-adherence were unemployment (OR = 4.44; 95% CI: 2.23-8.86), alcoholism (OR = 1.99; 95% CI: 1.04-3.81), homelessness OR = 3.49; 95% CI: 1.25-9.77). Social support reduced the outcome of non-compliance (OR = 0.13; 95% CI: 0.06-0.28). This analysis controls the effects of age, gender, area, place of residence, and sputum smear antacid staining. Conclusions: Unemployment, alcoholism and homelessness are the relevant factors that increase the risk of non-compliance of new TB patients. Conversely, social support reduces non-compliance. A further prospective randomized study in Russia to assess and determine the optimal cost-effectiveness of social support for improving TB treatment outcomes is necessary, especially in populations at higher risk of non-compliance.