肺結核病人服藥順從性與都治計畫實施的影響

Patient Adherence in Treatment of Tuberculosis and the Effect by Implementation of the DOTS Strategy

結核病仍然是世界上最重要的傳染性疾病之一。服藥順從性不良是造成不完整治療的關鍵，會導致治療失敗、疾病復發、病人死亡，細菌抗藥性的產生。肺結核病人的服藥順從性是由許多方面的因素共同影響的，像是病患本身社會經濟狀況，病人對於治療的了解和態度，醫病關係間的溝通，醫療資源的便利性和可用性等。都治計畫（directly observed therapy, short-course; DOTS，英文翻譯為短程直接觀察治療法，台灣疾病管制署譯作都治）是改善病人服藥順從性最重要的方法，自1990年代推行以來，在提高完治率、降低死亡率、失落率上皆有明顯幫助。直接觀察服藥的只是都治計畫的其中一部分，還需配合政府的政策和行動、準確診斷與追蹤、充足的醫藥資源、準確的藥物使用、以及有效監控評估，才能達到都治計畫的真正的成效。台灣也於2005年和2007年分別實施都治計畫和進階都治計畫（directly observed therapy, short-course-plus; 縮寫為DOTS-plus），目前台灣的結核病發生率也有顯著下降。在未來，除了都治計畫的實行外，潛伏結核感染的處理、多重抗藥性肺結核、愛滋病與結核病的共同感染等問題將會是在結核病防治上的重要議題。

Tuberculosis is responsible for one of the highest morbitity rates in the world. Poor adherence is the main cause of incomplete treatment, leading to treatment failure, relapse, death, and drug resistant TB. Patient adherence is influenced by multiple factors, such as social-economic status, understanding and attitude about the treatment, communication between medical staff and patients, and the availability of health care service. Directly observed therapy, short-course (DOTS) program is an important strategy for promoting patient adherence and has lead to a decrease in the worldwide incidence, prevalence and death rate of the disease since the mid-1990s. However, direct supervision of drug intake is only part of the DOTS program, which also includes government support and action, precise diagnosis and follow-up, adequate medical resources, effective treatment, supervision and evaluation. In Taiwan, the incidence of tuberculosis has noticeably decreased since the implementation of the DOTS and the DOTS-plus programs in 2005 and 2007, respectively. Other concerns, such as latent tuberculosis infection, multi-drug-resistant tuberculosis, and human immunodeficiency virus-tuberculosis co-infection, will be increasingly important for management of tuberculosis in the future.