结核与肺部疾病杂志 ›› 2022, Vol. 3 ›› Issue (6): 449-454.doi: 10.19983/j.issn.2096-8493.20220152

• 论著 • 上一篇    下一篇

四川省凉山彝族自治州结核病加强管理模式实施的可行性及有效性分析

李京, 何金戈(), 李婷, 李运葵, 高文凤   

  1. 四川省疾病预防控制中心结核病预防控制所,成都 610041
  • 收稿日期:2022-09-23 出版日期:2022-12-20 发布日期:2022-12-15
  • 通信作者: 何金戈 E-mail:hejinge@163.com
  • 基金资助:
    “十三五”国家科技重大专项(2018ZX10715003-002)

Analysis of feasibility and effectiveness of the implementation of strengthened tuberculosis management model in Liangshan Yi Autonomous Prefecture, Sichuan Province

Li Jing, He Jinge(), Li Ting, Li Yunkui, Gao Wenfeng   

  1. Tuberculosis Prevention and Control Institute, Sichuan Center for Disease Control and Prevention, Chengdu 610041, China
  • Received:2022-09-23 Online:2022-12-20 Published:2022-12-15
  • Contact: He Jinge E-mail:hejinge@163.com
  • Supported by:
    National Major Science and Technology Projects during the 13th Five-Year Plan(2018ZX10715003-002)

摘要:

目的: 在四川省凉山彝族自治州(简称“凉山州”)AIDS“1+M+N”网底模式的基础上,评价结核病加强管理模式对当地结核病管理的可行性和有效性。方法: 选取2019年1—12月在凉山州布拖县木尔乡、九都乡和特木里镇(简称“两乡一镇”)管理的,经知情同意后的688例HIV/AIDS患者作为研究对象。对所有研究对象同时进行结核病可疑症状筛查、胸部X线摄影检查和结核菌素皮肤试验。对确诊的利福平和异烟肼敏感肺结核患者的治疗方案为2H-R-Z-E/4H-R(H:异烟肼;R:利福平;Z:吡嗪酰胺;E:乙胺丁醇);对确认结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)且符合预防性抗结核治疗条件的HIV/AIDS患者进行预防性抗结核治疗,采取单用异烟肼方案,疗程为6个月。对研究对象和医务人员进行面对面访谈。应用结核病加强管理模式对患者进行随访管理。分析活动性肺结核患者流行病学特征、抗结核治疗转归和LTBI者预防性抗结核治疗转归情况。结果: 688例研究对象中发现活动性肺结核患者115例(16.7%),其中,91例(79.1%)活动性肺结核患者纳入治疗。纳入治疗的活动性肺结核患者中,成功治疗者有86例(94.5%)。符合预防性抗结核治疗者共565例,其中,453例(80.2%)实施预防性抗结核治疗者纳入服药组,其余112例(19.8%)纳入对照组。服药组完成治疗413例(91.2%)。经2年随访,服药组发病率为0.7%(3/453),对照组发病率为1.8%(2/112),差异无统计学意义(χ2=1.292,P=0.256);预防性抗结核治疗保护率为62.9%(1.1%/1.8%)。面对面访谈结果显示,少数民族地区由于受到当地传统风俗习惯的影响,居民对结核病防治工作的配合程度不一,有症状的患者配合,无症状者并不配合;对HIV/AIDS患者中的确诊结核病者和进行预防性抗结核治疗的LTBI者的抗结核治疗效果较好;部分被调查者对个人信息较为敏感,对本地区调查人员有抵触情绪。结论: 基于凉山州AIDS“1+M+N”网底工作模式的结核病加强管理模式,可强化“县-乡-村”医疗机构职责,拓宽基层结核病管理人员范畴,进一步提高患者管理工作效率,提升当地结核分枝杆菌合并HIV感染者抗结核治疗成功率,提高HIV/AIDS患者预防性抗结核治疗的覆盖率和完成率。

关键词: 结核, 获得性免疫缺陷综合征, 人群监测, 预防和防护用药, 病例管理

Abstract:

Objective: To evaluate the feasibility and effectiveness of strengthened tuberculosis management model for local tuberculosis management on the basis of AIDS “1+M+N” bottom-up model in Liangshan Yi Autonomous Prefecture (Liangshan Prefecture), Sichuan Province. Methods: A total of 688 HIV/AIDS patients who were managed in Muer Township, Jiudu Township and Temuli Township of Butuo County, Liangshan Prefecture (two townships and one town) from January to December 2019 with informed consent were selected as the study subjects. All the subjects were screened for suspicious symptoms of tuberculosis, chest X-ray and tuberculin skin test at the same time. The treatment plan for confirmed rifampicin and isoniazid sensitive pulmonary tuberculosis was 2H-R-Z-E/4H-R (H: isoniazid; R: rifampicin; Z: pyrazinamide; E: ethambutol); HIV/AIDS patients confirmed to have been infected with latent tuberculosis infection (LTBI) and meet the conditions for preventive anti-tuberculosis treatment were treated with preventive anti-tuberculosis treatment, and isoniazid alone was used for 6 months. Face to face interviews were conducted in the subjects and medical staff. Patients were followed up using the strengthened tuberculosis management model. The epidemiological characteristics of active pulmonary tuberculosis patients, the outcome of anti-tuberculosis treatment and the outcome of preventive anti-tuberculosis treatment for LTBI patients were analyzed. Results: Among the 688 subjects, 115 were active pulmonary tuberculosis patients (16.7%) of which 91 (79.1%) got the treatment, and 86 (94.5%) were successfully treated. Preventive anti-tuberculosis treatment applicable to 565 cases, of which 453 (80.2%) were in the drug group and 112 (19.8%) were in the control group. In the drug group, 413 cases (91.2%) completed the treatment. After two years of follow-up, the incidence rate of the drug group was 0.7% (3/453), and that of the control group was 1.8% (2/112), there was no statistically significant difference (χ2=1.292, P=0.256). The protection rate of preventive anti-tuberculosis treatment was 62.9% (1.1%/1.8%). The results of face-to-face interviews showed that due to the influence of local traditional customs and habits, residents in ethnic minority areas had different levels of cooperation in tuberculosis prevention and control. Patients with symptoms always cooperate, while those without symptoms did not; the effect of anti-tuberculosis treatment on HIV/AIDS patients complicated with tuberculosis and LTBI patients receiving preventive anti-tuberculosis treatment was better; some respondents were more sensitive to personal information and had resistance to investigators in the region. Conclusion: The tuberculosis management mode based on the “1+M+N” network bottom work mode of AIDS in Liangshan Prefecture should be strengthened on the responsibilities of “county-township-village” medical institutions, the scope of grass-roots tuberculosis managers should be broadened, to improve the efficiency of patient management and the success rate of anti-tuberculosis treatment for local patients with MTB/HIV co-infection, as well as to improve the coverage and completion rate of preventive anti-tuberculosis treatment for HIV/AIDS patients.

Key words: Tuberculosis, Acquired immunodeficiency syndrome, Population surveillance, Protective agents, Case management

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