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