对强制隔离戒毒所内符合条件的HIV感染与AIDS患者开展结核病预防性治疗的效果评价

Evaluation of the effect of isoniazid tuberculosis preventive therapy among eligible HIV-infected people and AIDS pa- tients in compulsory isolation detoxification center

目的评价对强制隔离戒毒所（简称“强戒所”）内符合条件的HIV感染者与AIDS患者开展结核病预防性治疗的效果。方法采取典型调查的方法，选择四川省资阳市某强戒所为研究现场。建立省、市、县三级CDC结核病、艾滋病防治所与强戒所医院的机构间协调沟通和技术保障机制，强化培训与健康宣传，对强戒所集中管理的553例HIV感染者与AIDS患者集中进行结核病筛查工作，同时采用结核病可疑症状问卷，以及进行胸部X线摄影、痰涂片、肝。肾功能和血常规检查，排除活动性结核病患者后，对肝肾功能正常并知情同意的305例HIV感染者与AIDS患者实施直接面视下服用异烟肼6个月的预防性治疗，并在服药过程的第1、2、4、6个月及完成治疗的第6、12个月对服药者进行了定期随访。由省级专家组负责质量控制，对所有异常胸片、痰涂片结果进行复核，并对随访过程进行工作督导。结果553例HIV感染者与AIDS患者中，确诊活动性结核病患者23例，结核病患者检出率为4．2％（23／553）；肝肾功能异常者43例（7．8％，43／553），近期将结束强制戒毒不能完成6个月治疗疗程者89例（16．I％，89／553）。符合结核病预防性治疗的398例HⅣ感染者与AIDS患者中，未签署知情同意书者93例（23．4％，93／398），实际进行结核病预防性治疗者305例（76．6％，305／398）；实施直接面视下进行异烟肼预防性治疗，完成6个月服药者297例，治疗完成率达到97．4％（297／305），服药依从性较好；随访中因不良反应退出服药者8例，不良反应发生率为2．6％（8／305）；预防性治疗后第6、12个月时的随访未出现新的活动性结核病患者。结论强制隔离戒毒所内对符合条件的HIV感染与AIDS患者进行结核病预防性治疗的效果良好，并且具备可推广性。

Objective To explore the mechanism HIV/AIDS in compulsory isolation detoxification center and effect of isoniazid preventive therapy for among eligible Methods A compulsory isolation detoxification center in Ziyang city of Sichuan province was selected as the research field via a typical survey method. We established me- chanism of communication, coordination and technology guarantee between CDC and compulsory isolation detoxifica- tion hospital, strengthened training and health promotion, and we carried out TB screening to 553 HIV/AIDS pa tients under the management of the detoxification hospital. Meanwhile, they were administered questionnaires sur- vey, X-ray, sputum smear, liver and kidney function and blood tests. After ruling out the active TB, 305 HIV/ AIDS patients with normal liver and kidney function and consented to the preventive therapy received the isoniazid directly observed preventive therapy for 6 months, and were followed in the 1st, 2nd, 4th, 6th month of treatment and 6th and 12th month after treatment completion. The provincial expert group was responsible for quality control with all the abnormal chest X-ray, sputum smear results review and follow-up work supervisiorL Results There were a total of 553 HIV/AIDS patients and 23 cases were confirmed active TB patients, with the detection rate of 4.2%（23/553） ;43 cases （7.8%,43/553）had abnormal liver function; 89 cases（16.1%,89/553）would soon end the compulsory detoxification; 93 cases（23.4%, 93/398）did not sign the consent form among those 398 cases who eligible for the isoniazid therapy; 305 cases（76.6%, 305/398）were given directly observed isoniazid preventive therapy, 297 completed six months of therapy with good medication compliance, treatment completion rate of 97.4% （297/305）. Eight quited due to adverse reactions due to adverse reaction, the adverse reaction rate was 2.6% （8/305）. None TB patients occurred during the 12-months follow-up after treatment completion. Concision Compulsory isolation detoxification center is an important place to carry out INH preventive therapy for among eligible HIV/AIDS, and the experience deserved extension.