Jia Yin1,2,3, Xiaomeng Wang4, Lin Zhou4, Xiaolin Wei5. 1. School of Health Care Management, Shandong University, Shandong, China. 2. Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, Shandong, China. 3. Center for Health Management and Policy Research, Shandong University, Shandong, China. 4. TB Department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, China. 5. Division of Clinical Public Health and Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) has been a major threat for successful TB control. We examined the relationship between social support and treatment outcomes in MDR-TB patients and evaluated barriers to social support. METHODS: Retrospective cohort study with MDR-TB patients enrolled in the Global Fund programme between 1 January 2009 and 30 June 2014 in Zhejiang, China. We reviewed all MDR-TB patients' diagnoses and treatment outcomes. In-depth interviews were conducted with 10 community health workers and 10 patients. Pathway analysis was employed to examine the association between social support and treatment outcomes, and the mediating effect of medication adherence on their relationship. RESULTS: Of 218 participants, 144 (66%) were successfully treated and 59 (27%) had poor treatment adherence. Directly observed therapy (DOT) had an indirect positive effect on treatment success, mediating through medication adherence (β = 0.541, P = 0.008; β = 0.538, P < 0.001). Financial support had both a direct (β = 0.769, P < 0.001) and an indirect positive effect on treatment success, which was mediated by a self-reported social support scale (β = 0.541, P = 0.008; β = 0.538, P < 0.001). The interviews indicated poor performance of DOT. Patients often suffered from substantial stigma, but were not provided with psychological support. CONCLUSION: DOT and financial support were effective strategies for improving successful treatment outcomes in MDR-TB patients, but they were delivered not considering patients' perspectives. There is an urgent need for consistent and specific psychological support for MDR-TB patients in their communities.
OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) has been a major threat for successful TB control. We examined the relationship between social support and treatment outcomes in MDR-TBpatients and evaluated barriers to social support. METHODS: Retrospective cohort study with MDR-TBpatients enrolled in the Global Fund programme between 1 January 2009 and 30 June 2014 in Zhejiang, China. We reviewed all MDR-TBpatients' diagnoses and treatment outcomes. In-depth interviews were conducted with 10 community health workers and 10 patients. Pathway analysis was employed to examine the association between social support and treatment outcomes, and the mediating effect of medication adherence on their relationship. RESULTS: Of 218 participants, 144 (66%) were successfully treated and 59 (27%) had poor treatment adherence. Directly observed therapy (DOT) had an indirect positive effect on treatment success, mediating through medication adherence (β = 0.541, P = 0.008; β = 0.538, P < 0.001). Financial support had both a direct (β = 0.769, P < 0.001) and an indirect positive effect on treatment success, which was mediated by a self-reported social support scale (β = 0.541, P = 0.008; β = 0.538, P < 0.001). The interviews indicated poor performance of DOT. Patients often suffered from substantial stigma, but were not provided with psychological support. CONCLUSION: DOT and financial support were effective strategies for improving successful treatment outcomes in MDR-TBpatients, but they were delivered not considering patients' perspectives. There is an urgent need for consistent and specific psychological support for MDR-TBpatients in their communities.
Authors: Holly A Taylor; David W Dowdy; Alexandra R Searle; Andrea L Stennett; Vadim Dukhanin; Alice A Zwerling; Maria W Merritt Journal: SSM Qual Res Health Date: 2022-01-28
Authors: Jennifer Furin; Marian Loveday; Sindisiwe Hlangu; Lindy Dickson-Hall; Sacha le Roux; Mark Nicol; Helen Cox Journal: BMC Public Health Date: 2020-01-17 Impact factor: 4.135
Authors: Angella Musiimenta; Wilson Tumuhimbise; Esther C Atukunda; Aaron T Mugaba; Conrad Muzoora; Mari Armstrong-Hough; David Bangsberg; J Lucian Davis; Jessica E Haberer Journal: Tuberc Res Treat Date: 2020-01-07
Authors: Qingchun Li; Cynthia X Shi; Min Lu; Limin Wu; Yifei Wu; Meng Wang; Le Wang; Gang Zhao; Li Xie; Han-Zhu Qian Journal: Medicine (Baltimore) Date: 2020-07-24 Impact factor: 1.817