在结核病患者儿童/青少年密切接触者中开展结核病预防性治疗的可行性定性研究  

Qualitative study on feasibility and aceptability of chemical prophylaxis for children/adolescents contacts with latent tuberculosis infection

作　　者：李阳 周昌明[1] 郑亦慧 路丽苹[3] 杨美霞[4] 袁政安[5] 胡屹[1] 徐飚[1] LI Yang;ZHOU Chang-ming;ZHENG Yi-hui;LU Li-ping;YANG Mei-xia;YUAN Zheng-an;HU Yi;XU Biao(School of Public Health/Key Laboratory of Public Health Safety(Ministry of Education),Fudan University,Shanghai 200032,China;Putuo District Center for Disease Control and Prevention,Shanghai 200333,China;Songjiang District Center for Disease Control and Prevention,Shanghai 201620,China;Xuhui District Center for Disease Control and Prevention,Shanghai 200237,China;Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]复旦大学公共卫生学院/公共卫生安全教育部重点实验室,上海200032 [2]上海市普陀区疾病预防控制中心,上海200333 [3]上海市松江区疾病预防控制中心,上海201620 [4]上海市徐汇区疾病预防控制中心,上海200237 [5]上海市疾病预防控制中心,上海200336

出　　处：《上海预防医学》2018年第3期170-175,共6页Shanghai Journal of Preventive Medicine

基　　金：国家科技部十三五传染病重大专项(2017ZX10105012)

摘　　要：【目的】了解在结核病患者儿童/青少年密切接触者中推广结核潜隐感染(LTBI)预防性治疗的可接受性、可行性及相关影响因素。【方法】2015年8月—2016年1月对上海市3个区内从事结核病防治相关工作的服务提供者[疾病预防控制中心(CDC)结防科工作人员和社区卫生服务中心结核病防治医生]以及儿童/青少年密切接触者家长分别采用焦点组访谈形式进行调查。访谈主要围绕儿童/青少年密切接触者接受结核病筛查现状、LTBI预防性治疗可接受性和治疗服务推广可行性等问题。借助Nvivo 10.0定性分析软件,将原始转录资料进行编码,按照不同的主题将所标记的内容归类,并不断完善主题框架。待编码和归类工作完成后,基于最终的主题框架进行综合分析。【结果】共完成焦点组访谈9组,涵盖12名CDC结防科工作人员、20名社区医生以及18名儿童/青少年密切接触者家长。访谈发现儿童/青少年密切接触者的结核病筛查以症状询问、查看接种证和拍摄X线胸片为主;由于担心辐射影响生长发育、结核纯蛋白衍生物(PPD)试剂短缺等主客观因素导致了筛查服务的实际利用率不高。大多数家长对LTBI预防性治疗持赞成态度,认为其可以预防活动性肺结核的发生;但家长对LTBI知识了解不足、担心药物不良反应等进一步限制了其对预防性治疗的接受性。卫生服务提供者能意识到在儿童/青少年密切接触者中开展LTBI预防性治疗的益处,但他们认为该项服务的推广会受到药物不良反应、耐药出现、治疗成本高、周期长和疗效指标不明确等因素的限制。【结论】开展LTBI健康教育将有利于提高密切接触者家长对预防性治疗的接受性。进一步推广该服务需要建立以定点医院为主体、CDC和社区卫生服务中心协同管理、家长和学校监督服药的模式。[Objective]To ascertain the acceptability and feasibility of chemical prophylaxis for children and adolescent contacts with latent tuberculosis infection(LTBI).[Methods]Nine focus group discussions(FGDs)were conducted in three districts of Shanghai from August 2015 to January 2016.A total of 50 participants were recruited including 18 parents with household TB patients and 32 health care providers.Questions on children and adolescents contacts TB screening,acceptability and feasibility of chemical prophylaxis for children with LTBI were interviewed by FGDs.Nvivo 10.0 was used to identify the key massages from these FGDs through coding,categorization and grouping into corresponding themes.[Results]Although symptom inquiry and Chest-X-ray were provided for children and adolescent contacts,but few of them received TB screening due to the shortage of PPD and concerns of radiation.Most of parents held positive attitudes to chemical prophylaxis with the consideration of preventing active TB.Shortage of knowledge about LTBI and chemo-prophylaxis made it difficult to get the permission on prophylaxis for children contacts with LTBI.Health providers could understand the potential benefits about chemoprophylaxis but still thought it unfeasible considering the adverse drug reaction,high costs for medication,long duration and unobservable effects of LTBI prophylaxis.[Conclusion]For providing LTBI screening and chemoprophylaxis for children and adolescent contacts,cooperation between household,CDC,communities and hospitals should be established for further surveillance of adverse drug reaction.Health education on LTBI and prophylaxis need to be strengthened.

关 键 词：结核潜隐感染 预防性治疗 可行性 定性研究 

分 类 号：R52[医药卫生—内科学]