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“Side effects--part of the package”: a mixed methods approach to study adverse events among patients being programmatically treated for DR-TB in Gujarat, India

机译:“副作用 - 包装的一部分”:一种混合方法,用于在印度古吉拉特邦古吉拉特德DR-TB以编程方式治疗的患者不良事件的方法

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High rates of Adverse Events (AEs) during treatment is one of the leading causes of unsuccessful treatment outcomes among patients with drug resistant tuberculosis (DR-TB). However, information related to AEs is not systematically collected and managed under programmatic setting. The present study assessed the a) incidence and pattern of adverse events in first three months of DR-TB treatment initiation; b) treatment seeking behaviour for AE management; and c) explore the challenges in seeking treatment and reporting AEs. This mixed methods study included all patients diagnosed and initiated on treatment under RNTCP during July–September 2018 at Ahmedabad DR-TB centre. The patients were interviewed telephonically and assessed for all AEs experienced by them. In-depth interviews and key-informant interviews were conducted among patients, DOTS supervisors and programme staff (treatment supervisors, medical officer and district program managers). Total 207 AEs were reported by the 74 DR-TB patients. All patients experienced at least one AE during initial treatment period. Incidence rate of AEs (experienced) was 3.11 (1st month-4.6, 2nd month-2.7, 3rd month-2.02) per 100 person days. Of the 207 AEs, gastro-intestinal (59, 28.3%), ophthalmic (32, 15.4%) and otolaryngology (25, 11.9%) system related AEs were commonly experienced. Treatment was not sought in two-fifths of the AEs. Themes and sub-themes related to challenges in treatment seeking or reporting of AEs were 1) Patient related-Misconceptions, accessibility and affordability of management, lack of counselling support, stigma and discrimination, and past treatment experience; 2) Health system related- lack of guidelines and training for AE management, 3) Poor coordination between hospital and tuberculosis centre. The incidence of AEs was high among patients with DR-TB in the first three months of treatment and treatment seeking/reporting was low. Adequate health education and counselling of the patient and orientation of the health systems is?the need of the hour. An efficient real-time reporting and management of AE should be developed and tested for effective DR-TB control.
机译:治疗期间的高不良事件(AES)的高率是耐药结核病患者(DR-TB)的患者治疗结果不成功的主要原因之一。但是,在编程设置下没有系统地收集和管理与AE相关的信息。本研究评估了a)发病率和前三个月的不良事件模式,在DR-TB治疗开始的前三个月; b)治疗AE管理的寻求行为; c)探索寻求治疗和报告AES的挑战。这种混合方法研究包括在2018年9月至2018年9月在Ahmedab​​ad DR-TB Center期间诊断和发起的所有患者。患者接受访电话,并为他们所经历的所有AES评估。在患者,DOTS监督员和计划工作人员(治疗监督员,医务人员和地区计划经理)中进行了深入的访谈和关键信息访谈。 74例DR-TB患者报告了207个AES。所有患者在初始治疗期间至少经历了至少一种AE。 AES(经验丰富)的发病率为3.11(每100人的第4.6节)(第4.6,第2个月-2.7,第3个月-2.02)。在207 AES中,通常经历过胃肠(32,28.3%),眼科(32,15.4%)和耳鼻喉科(25,11.9%)相关AES。治疗未寻求五分之二的AES。与治疗或报告AES的挑战有关的主题和子主题是1)患者相关的误解,管理,缺乏咨询支持,耻辱和歧视,以及过去的治疗经验; 2)卫生系统相关 - 缺乏对AE管理的准则和培训,3)医院和结核中心之间的协调不良。在治疗的前三个月DR-TB的患者中,AES的发病率高,治疗/报告的治疗率低低。适当的健康教育和卫生系统患者的咨询是什么时候的需求。应开发和测试AE的有效实时报告和管理,以获得有效的DR-TB控制。

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