对中国监狱犯人结核病防治干预策略的循证评价

Evidence-based Review of the Intervention Strategies on the TB Prevention and Treatment among Prisoners in China

目的调查分析既往及正在执行的结核病控制项目在改善中国监狱犯人对结核病服务获得和利用方面所采取的相关政策文件、干预措施等,并评价其效果和影响,为进一步开展监狱结核病防治工作提供依据和建议。方法计算机检索MEDLINE、PubMed、CNKI、中国生物医学文献数据库(CBMdisc)、万方学位论文全文数据库、VIP,查找1988～2008年已发表的关于中国监狱犯人结核病防治工作的文献。同时采用非概率目的性抽样方法,在获得访谈对象知情同意后进行了定性访谈。结果共检索到23篇文献,其中符合纳入标准的已发表文献8篇,政策文件5篇。二次文献研究结果显示,我国目前对监狱犯人结核病防治采取的措施是:通过普查、逢监必检及因症就诊发现病人;根据羁押人员的不同人群类别,采取"分类指导管理,集中收治管理"的干预措施;在监狱开展健康教育等。采取不同干预措施后病人知识知晓率、结核病发现率、治疗完成率、结核病治愈率等均有很大提高。定性访谈结果显示,监狱结核病犯人及疑似病例均能够被集中隔离,并按现代结核病控制策略(DOT)进行管理;狱医能得到结核病治疗方面的培训,做到持证上岗。结论从已发表、二次文献及定性访谈结果来看,DOTS在该人群中实施得较好,效果显著。

Objective To investigate and analyze the past and on-going pro-poor programs related to health equity, and the relevant policies, documents, interventions measures, etc. to improve the China prisoners＇ accessibility and utilization of tuberculosis （TB） control services in TB control programs, then evaluate their impacts and influences to provide evidences and suggestions for the further work of TB prevention and treatment. Methods Retrieve published documents about TB prevention and treatment of transient population dating from 1998 to 2008 from MEDLINE, PubMed, CNKI, CBMdisc CDDB and VIP with computers. Simultaneously, a series of interviews was conducted after we got the agreement of the interview people by using non-probability statistics methods. Results A total of 23 documents were retrieved, and they were consonant with the criteria, among which 8 were published and 5 were policy documents. The study on the second document showed the measures that presently applied on TB patients among prisoners in China： find patients through surveys, inspect every prisons and patients going to visit doctors with symptoms; concerning differences between various groups of prisoners, the measure of ＂classify and instruction, enroll together and treat＂ was applied; carry out health education in the prisons and so on. After the implement of various measures, the knowledge awareness, discovery rate, accomplishment ratio, cure rate and so on were all improved. The results of the qualitative interviews showed： the TB patients and the doubts among prisoners could be well gotten together and isolated to receive DOTS; doctors were able to receive trainings on TB treatment and take appointment with certificate. Conclusion According to the results of qualitative interviews, the published and the secondary documents, it could be seen that DOTS are well implemented with remarkable effects.