结核病防治医务工作者开展预防性抗结核治疗工作意愿调查及影响因素分析  

Investigation on the willingness of tuberculosis health-care workers to implement tuberculosis preventive treatment and analysis of influencing factors

作　　者：李锦浩 胡冬梅[1] 徐彩红[1,2] Li Jinhao;Hu Dongmei;Xu Caihong(National Center for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]中国疾病预防控制中心结核病预防控制中心,北京102206 [2]中国疾病预防控制中心传染病溯源预警与智能决策全国重点实验室,北京102206

出　　处：《中国防痨杂志》2025年第4期398-407,共10页Chinese Journal of Antituberculosis

基　　金：2025年结核病预防控制项目。

摘　　要：目的:调查结核病防治医务工作者(tuberculosis health-care workers,TB-HCWs)开展预防性抗结核治疗(tuberculosis preventive treatment,TPT)工作的意愿,并分析其影响因素,为我国进一步推广TPT工作提供参考。方法:采用横断面方便抽样调查方法,选取我国11个省(自治区)的综合医院、慢性病防治院、结核病专科医院、结核病防治所、疾病预防控制中心(简称“疾控中心”)和基层医疗机构,采用自行设计的调查问卷对机构中自愿参与的TB-HCWs进行开展TPT工作意愿、筛查方法、治疗方法的问卷调查,并采用logistic多因素模型对开展TPT工作意愿的影响因素进行分析。结果:14291名被调查者中,13176名(92.20%)TB-HCWs有意愿开展TPT工作。多因素分析显示,高中及以下、大专、大学学历者开展TPT工作的意愿均高于研究生及以上学历者(分别为OR=1.782,95%CI:1.196~2.626,P=0.004;OR=1.866,95%CI:1.291~2.657,P=0.001;OR=1.841,95%CI:1.295~2.577,P<0.001);基层医疗机构和其他工作单位人员的意愿均高于疾控中心人员(分别为OR=1.542,95%CI:1.140~2.077,P=0.005;OR=2.745,95%CI:1.699~4.589,P<0.001);结核病定点医疗机构TB-HCWs的意愿高于非定点医疗机构(OR=1.217,95%CI:1.043~1.423,P=0.013)。愿意开展TPT工作的前三位原因包括能够降低结核病发病率[97.24%(12813/13176)]、可以保护高危人群[81.32%(10715/13176)]和有专业的技术人员提供指导[71.33%(9398/13176)],不愿意开展的前三位原因包括担心TPT会造成获得性耐药[75.41%(138/183)]、会造成不良反应[72.68%(133/183)]和无法完全保证疗效[65.03%(119/183)]。52.25%(6885/13176)愿意开展TPT的TB-HCWs曾参与过TPT,其中,使用结核菌素皮肤试验、结核抗原皮肤试验和γ-干扰素释放试验等作为筛查方法的TB-HCWs分别占94.89%(6533/6885)、62.02%(4270/6885)和57.60%(3966/6885),采用3HR、6~9H、免疫预防、3HP和4R作为治疗方案的TB-HCWs占比分别为74.09%(5101/6885)、64.71%(4455/6885)�Objective:To investigate the willingness of tuberculosis health-care workers(TB-HCWs)to implement tuberculosis preventive treatment(TPT)and analyze influencing factors,providing reference for scaling up TPT in China.Methods:A cross-sectional survey was conducted across 11 provinces in China,targeting TB-HCWs from general hospitals,chronic disease hospitals,TB-specialized hospitals,TB control institutes,centers for disease control(CDC)and prevention and primary healthcare institutions.A self-designed questionnaire was used to assess TB-HCWs’willingness to implement TPT,screening method and treatment method.Multivariate logistic regression models were applied to identify influencing factors.Results:Among 14291 participants,92.20%(13176/14291)expressed willingness to implement TPT.Multivariate analysis revealed that higher willingness among TB-HCWs with high school or lower education,college diplomas,and bachelor’s degrees compared to those with postgraduate degrees(OR=1.782,95%CI:1.196-2.626,P=0.004;OR=1.866,95%CI:1.291-2.657,P=0.001;OR=1.841,95%CI:1.295-2.577,P<0.001).Staff in primary healthcare institutions and other institutions showed higher willingness than CDC personnel(OR=1.542,95%CI:1.140-2.077,P=0.005;OR=2.745,95%CI:1.699-4.589,P<0.001).Notably,TB-HCWs in TB-designated medical institutions demonstrated greater willingness than those in non-designated facilities(OR=1.217,95%CI:1.043-1.423,P=0.013).The primary motivations for willingness included reducing TB incidence(97.24%(12813/13176)),protecting high-risk populations(81.32%(10715/13176)),and availability of professional guidance(71.33%(9398/13176)),whereas concerns about drug resistance(75.41%(138/183)),adverse reactions(72.68%(133/183)),and efficacy uncertainty(65.03%(119/183))were predominant barriers.52.25%(6885/13176)of willing TB-HCWs had previously participated in TPT.Among them,TB-HCWs using tuberculin skin test(PPD),TBST,and IGRAs as screening methods accounted for 94.89%(6533/6885),62.02%(4270/6885),and 57.60%(3966/6885),respectively.TB-HCWs

关 键 词：结核 医务人员 问卷调查 预防和防护用药 干预性研究 因素分析 统计学 

分 类 号：R52[医药卫生—内科学] R192[医药卫生—临床医学]