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

doi:10.19982/j.issn.1000-6621.20240427

Abstract

Abstract:

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 adopting 3HR, 6-9H, immunoprophylaxis, 3HP, and 4R as treatment regimens accounted for 74.09% (5101/6885), 64.71% (4455/6885), 59.23% (4078/6885), 57.47% (3957/6885), and 49.75% (3425/6885), respectively. Conclusion: TB-HCWs in China currently exhibit high willingness to implement TPT, yet disparities exist across educational backgrounds, institutional levels, and facility types. Targeted training and policy support are critical to accelerate TPT implementation and reduce tuberculosis burden.

Key words: Tuberculosis, Medical staff, Questionnaires, Protective agents, Intervention studies, Factor analysis, statistical

CLC Number:

R52
R192

Li Jinhao, Hu Dongmei, Xu Caihong. Investigation on the willingness of tuberculosis health-care workers to implement tuberculosis preventive treatment and analysis of influencing factors[J]. Chinese Journal of Antituberculosis, 2025, 47(4): 398-407. doi: 10.19982/j.issn.1000-6621.20240427

Figures/Tables 5

影响因素	s $x ˉ$ 值	β值	Z值	P值	OR(95%CI)值
年龄组(岁)
18~29					1.000
30~39	0.087	-0.079	-0.910	0.363	0.924(0.780~1.095)
40~49	0.096	-0.009	-0.099	0.921	0.991(0.821~1.197)
≥50	0.122	0.152	1.249	0.212	1.164(0.919~1.482)
文化程度
高中及以下	0.200	0.578	2.882	0.004	1.782(1.196~2.626)
大专	0.184	0.624	3.391	0.001	1.866(1.291~2.657)
大学	0.175	0.611	3.484	<0.001	1.841(1.295~2.577)
研究生及以上					1.000
地区
东部	0.268	0.413	1.542	0.123	1.512(0.867~2.495)
中部					1.000
西部	0.265	0.266	1.002	0.316	1.305(0.752~2.141)
单位级别
省级					1.000
地/市级	0.275	0.371	1.348	0.178	1.450(0.829~2.451)
县级	0.265	-0.010	-0.036	0.971	0.990(0.576~1.634)
乡镇及以下	0.275	-0.048	-0.173	0.862	0.953(0.544~1.606)
单位类型
综合医院	0.136	0.186	1.372	0.170	1.205(0.921~1.568)
结核病专科医院或防治所	0.283	0.364	1.286	0.199	1.440(0.843~2.572)
疾控中心					1.000
基层医疗机构	0.153	0.433	2.833	0.005	1.542(1.140~2.077)
其他工作单位类型	0.253	1.010	3.997	<0.001	2.745(1.699~4.589)
是否是结核病定点医疗机构
是	0.079	0.196	2.482	0.013	1.217(1.043~1.423)
否					1.000
工作年限(年)
≤1					1.000
2~5	0.083	0.058	0.708	0.479	1.060(0.902~1.247)
6~10	0.095	-0.156	-1.640	0.101	0.855(0.710~1.032)
11~20	0.119	0.139	1.169	0.243	1.150(0.912~1.457)
≥21	0.133	-0.053	-0.402	0.688	0.948(0.733~1.233)

原因	调查		选择		s $x ˉ$ 值		β值		Z值			P值	OR(95%CI)值
原因1:能够降低结核病发病率
疾控中心	826(6.27)		808(97.82)										1.000
综合医院	2935(22.28)		2859(97.41)		0.268		-0.103		-0.383			0.702	0.902(0.518~1.492)
结核病专科医院或防治所	260(1.97)		253(97.31)		0.455		-0.147		-0.323			0.747	0.863(0.368~2.257)
基层医疗机构	8625(65.46)		8386(97.23)		0.256		0.124		0.484			0.628	1.132(0.663~1.819)
其他工作单位类型	530(4.02)		507(95.66)		0.329		-0.203		-0.617			0.537	0.816(0.424~1.551)
小计	13176(100.00)		12813(97.24)
原因2:可以保护高危人群
疾控中心	826(6.27)		660(79.90)										1.000
综合医院	2935(22.28)		2456(83.68)		0.101		0.271		2.676			0.007	1.312(1.073~1.598)
结核病专科医院或防治所	260(1.97)		214(82.31)		0.193		0.276		1.432			0.152	1.318(0.911~1.944)
基层医疗机构	8625(65.46)		6970(80.81)		0.095		0.186		1.960			0.050	1.205(0.998~1.448)
其他工作单位类型	530(4.02)		415(78.30)		0.139		0.029		0.211			0.833	1.030(1.784~1.355)
小计	13176(100.00)		10715(81.32)
原因3:有专业的技术人员提供指导
疾控中心	826(6.27)		454(54.96)										1.000
综合医院	2935(22.28)		2038(69.44)		0.082		0.634		7.735			<0.001	1.886(1.605~2.214)
结核病专科医院或防治所	260(1.97)		158(60.77)		0.147		0.229		1.552			0.121	1.257(0.943~1.681)
基层医疗机构	8625(65.46)		6358(73.72)		0.077		0.718		9.263			<0.001	2.049(1.760~2.385)
其他工作单位类型	530(4.02)		390(73.58)		0.124		0.699		5.630			<0.001	2.012(1.580~2.570)
小计	13176(100.00)		9398(71.33)
原因4:有相关的政策支持
疾控中心		826(6.27)		459(55.57)									1.000
综合医院		2935(22.28)		1905(64.91)		0.081		0.402		4.950	<0.001		1.495(1.274~1.752)
结核病专科医院或防治所		260(1.97)		162(62.31)		0.148		0.241		1.629	0.103		1.272(0.954~1.703)
基层医疗机构		8625(65.46)		6113(70.88)		0.077		0.525		6.818	<0.001		1.691(1.453~1.966)
其他工作单位类型		530(4.02)		381(71.89)		0.123		0.541		4.414	<0.001		1.717(1.353~2.187)
小计		13176(100.00)		9020(68.46)
原因5:有相关的经费支持
疾控中心		826(6.27)		344(41.65)									1.000
综合医院		2935(22.28)		1516(51.65)		0.081		0.431		5.337	<0.001		1.539(1.314~1.804)
结核病专科医院或防治所		260(1.97)		112(43.08)		0.146		0.050		0.346	0.729		1.052(0.790~1.398)
基层医疗机构		8625(65.46)		4976(57.69)		0.077		0.554		7.213	<0.001		1.740(1.497~2.023)
其他工作单位类型		530(4.02)		302(56.98)		0.116		0.536		4.633	<0.001		1.709(1.363~2.145)
小计		13176(100.00)		7250(55.02)
原因6:有足够的人员
疾控中心		826(6.27)		128(15.50)									1.000
综合医院		2935(22.28)		1011(34.45)		0.105		1.015		9.637	<0.001		2.759(2.251~3.403)
结核病专科医院或防治所		260(1.97)		61(23.46)		0.178		0.508		2.849	0.004		1.662(1.167~2.349)
基层医疗机构		8625(65.46)		3130(36.29)		0.102		0.958		9.431	<0.001		2.606(2.143~3.192)
其他工作单位类型		530(4.02)		181(34.15)		0.137		0.924		6.769	<0.001		2.520(1.930~3.298)
小计		13176(100.00)		4511(34.24)

References 32

[1]	World Health Organization. Global tuberculosis report 2024. Geneva: World Health Organization, 2024.
[2]	Mack U, Migliori GB, Sester M, et al. LTBI: latent tuberculosis infection or lasting immune responses to M.tuberculosis? A TBNET consensus statement. Eur Respir J, 2009, 33(5): 956-973. doi:10.1183/09031936.00120908. pmid: 19407047
[3]	Sterling TR, Njie G, Zenner D, et al. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep, 2020, 69(1): 1-11. doi:10.15585/mmwr.rr6901a1. pmid: 32053584
[4]	姚旭, 吴成果, 龚德华, 等. 肺结核患者密切接触者12周预防性治疗方案的服药情况及影响因素分析. 中国防痨杂志, 2021, 43(3): 233-239. doi:10.3969/j.issn.1000-6621.2021.03.008.
[5]	World Health Organization. Guidelines on the Management of Latent Tuberculosis Infection. Geneva: World Health Organization, 2015.
[6]	World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: World Health Organization, 2018.
[7]	World Health Organization. WHO consolidated guidelines on tuberculosis: Module 1: prevention: tuberculosis preventive treatment. Geneva: World Health Organization, 2020.
[8]	World Health Organization. WHO consolidated guidelines on tuberculosis: Module 1: Prevention: Tuberculosis preventive treatment second edition. Geneva: World Health Organization, 2024.
[9]	中国医学科学院病原生物学研究所,中国疾病预防控制中心,中国科学院地理科学与资源研究所. 全国结核分枝杆菌潜伏感染率估算专家共识. 中国防痨杂志, 2022, 44(1): 4-8. doi:10.19982/j.issn.1000-6621.20210662.
[10]	国家卫生健康委员会, 国家发展和改革委员会, 教育部, 等. 关于印发遏制结核病行动计划(2019—2022年)的通知. 国卫疾控发〔2019〕41号. 2019-05-31.
[11]	国家卫生健康委员会办公厅. 国家卫生健康委办公厅关于印发中国结核病预防控制工作技术规范(2020年版)的通知. 国卫办疾控函〔2020〕279号. 2020-04-02.
[12]	刘惠, 闻颖. 艾滋病患者和HIV感染者中结核潜伏性感染的诊断与预防性治疗. 中国防痨杂志, 2016, 38(1): 57-60. doi:10.3969/j.issn.1000-6621.2016.01.013.
[13]	中国性病艾滋病防治协会HIV合并结核病专业委员会. 人类免疫缺陷病毒感染/艾滋病合并结核分枝杆菌感染诊治专家共识. 中华传染病杂志, 2022, 40(1): 6-19. doi:10.3760/cma.j.cn311365-20211105-00387.
[14]	李阳, 周昌明, 郑亦慧, 等. 在结核病患者儿童/青少年密切接触者中开展结核病预防性治疗的可行性定性研究. 上海预防医学, 2018, 30(3): 170-175. doi:10.19428/j.cnki.sjpm.2018.18663.
[15]	杨震, 雷囡, 赵飞, 等. 北京市昌平区高等院校新生结核分枝杆菌潜伏感染状况调查及潜伏感染者预防性治疗效果分析. 结核与肺部疾病杂志, 2022, 3(4): 274-280. doi:10.19983/j.issn.2096-8493.20220109.
[16]	曹红, 钱冰, 吴金菊. 学校结核病疫情现状及防控工作研究进展. 结核与肺部疾病杂志, 2024, 5(1): 88-92. doi:10.19983/j.issn.2096-8493.20230115.
[17]	魏靖入, 陈卉, 成君. 高中学生肺结核筛查和预防性治疗研究进展. 结核与肺部疾病杂志, 2024, 5(4): 358-363. doi:10.19983/j.issn.2096-8493.2024072.
[18]	辛赫男. 中国农村结核潜伏感染人群五年发病特征及相关影响因素. 中国防痨杂志, 2019, 41(8): 892. doi:10.3969/j.issn.1000-6621.2019.08.016.
[19]	任哲雯, 张国龙, 龚德华, 等. 结核潜伏感染者对12周预防性治疗方案的接受意愿研究. 中国防痨杂志, 2020, 42(5): 503-509. doi:10.3969/j.issn.1000-6621.2020.05.016.
[20]	任哲雯. 肺结核患者密切接触者预防性治疗可接受性研究. 北京: 中国疾病预防控制中心, 2021.
[21]	谢蓝田. 风湿免疫病人群预防性抗结核治疗接受度的定量研究——结核病认知、潜伏结核感染筛查及预防性抗结核治疗接受度及偏好的问卷调查. 北京: 中国医学科学院, 2023.
[22]	Fa L, Xu C, Cheng J, et al. Acceptability of Tuberculosis Preventive Treatment Strategies Among Healthcare Workers Using an Online Survey-China, 2021. China CDC Wkly, 2022, 4(11): 211-215. doi:10.46234/ccdcw2022.050.
[23]	Zakaria WMZ, Mansor Z. Intention to receive Latent Tuberculosis Infection (LTBI) treatment and its associated factors among healthcare workers in a Malaysian teaching university hospital. PLoS One, 2024, 19(7): e0307199. doi:10.1371/journal.pone.0307199.
[24]	Assefa DG, Bedru A, Zeleke ED, et al. Efficacy and safety of different regimens in the treatment of patients with latent tuberculosis infection: a systematic review and network meta-analysis of randomized controlled trials. Arch Public Health, 2023, 81(1): 82. doi:10.1186/s13690-023-01098-z.
[25]	den Boon S, Matteelli A, Getahun H. Rifampicin resistance after treatment for latent tuberculous infection: a systematic review and meta-analysis. Int J Tuberc Lung Dis, 2016, 20(8): 1065-1071. doi:10.5588/ijtld.15.0908. pmid: 27393541
[26]	Balcells ME, Thomas SL, Godfrey-Faussett P, et al. Isoniazid preventive therapy and risk for resistant tuberculosis. Emerg Infect Dis, 2006, 12(5): 744-751. doi:10.3201/eid1205.050681. pmid: 16704830
[27]	Sotgiu G, Matteelli A, Getahun H, et al. Monitoring toxicity in individuals receiving treatment for latent tuberculosis infection: a systematic review versus expert opinion. Eur Respir J, 2015, 45(4): 1170-1173. doi:10.1183/09031936.00216814. pmid: 25700378
[28]	Zenner D, Beer N, Harris RJ, et al. Treatment of Latent Tuberculosis Infection: An Updated Network Meta-analysis. Ann Intern Med, 2017, 167(4): 248-255. doi:10.7326/M17-0609. pmid: 28761946
[29]	Zhou G, Luo S, He J, et al. Effectiveness and safety of tuberculosis preventive treatment for contacts of patients with multidrug-resistant tuberculosis: a systematic review and meta-analysis. Clin Microbiol Infect, 2024, 30(2): 189-196. doi:10.1016/j.cmi.2023.09.015.
[30]	Duthie MS, Reed SG. Skin tests for the detection of Mycobacterial infections: achievements, current perspectives, and implications for other diseases. Appl Microbiol Biotechnol, 2021, 105(2): 503-508. doi:10.1007/s00253-020-11062-4. pmid: 33394146
[31]	Shah R, Khakhkhar T, Modi B. Efficacy and Safety of Different Drug Regimens for Tuberculosis Preventive Treatment: A Systematic Review and Meta-Analysis. Cureus, 2023, 15(4): e38182. doi:10.7759/cureus.38182.
[32]	李圆圆, 刘思明. 关于注射用微卡预防性治疗潜伏性结核感染可行性的研究. 长寿, 2022 (4): 114-116.

基本特征	调查	有意愿	χ²值	P值	基本特征	调查	有意愿	χ²值	P值
年龄组(岁)			8.498	0.037	单位级别			9.298	0.026
18~29	3963(27.73)	3656(92.25)			省级	209(1.46)	188(89.95)
30~39	4030(28.20)	3684(91.41)			地/市级	974(6.82)	904(92.81)
40~49	3728(26.09)	3436(92.17)			县级	2730(19.10)	2483(90.95)
≥50	2570(17.98)	2400(93.39)			乡镇及以下	10378(72.62)	9601(92.51)
性别			0.232	0.630	单位类型			28.144	<0.001
男性	5096(35.66)	4691(92.05)			综合医院	3214(22.49)	2935(91.32)
女性	9195(64.34)	8485(92.28)			结核病专科医院或防治所	279(1.95)	260(93.19)
民族			1.703	0.192	疾控中心	928(6.49)	826(89.01)
汉族	12298(86.05)	11324(92.08)			基层医疗机构	9316(65.19)	8625(92.58)
其他民族	1993(13.95)	1852(92.93)			其他单位类型	554(3.88)	530(95.67)
文化程度			15.979	0.001	是否是结核病定点医疗机构			5.099	0.024
高中及以下	2543(17.79)	2363(92.92)			是	4507(31.54)	4189(92.94)
大专	5644(39.49)	5218(92.45)			否	9784(68.46)	8987(91.85)
大学	5701(39.89)	5243(91.97)			工作年限(年)			9.854	0.043
研究生及以上	403(2.83)	352(87.34)			≤1	4912(34.37)	4520(92.02)
地区			6.018	0.049	2~5	3716(26.00)	3435(92.44)
东部	5698(39.87)	5290(92.84)			6~10	2295(16.06)	2086(90.89)
中部	185(1.30)	167(90.27)			11~20	1805(12.63)	1684(93.30)
西部	8408(58.83)	7719(91.81)			≥21	1563(10.94)	1451(92.83)

变量	赋值
是否愿意开展TPT工作	0=不愿意;1=愿意
年龄组	1=18~29岁;2=30~39岁;3=40~49岁;4=≥50岁
文化程度	1=高中及以下;2=大专;3=大学;4=研究生及以上
地区	1=东部;2=中部;3=西部
单位类型	1=综合医院;2=结核病专科医院或防治所;3=疾控中心;4=基层医疗机构;5=其他单位类型
单位是否是结核病定点医疗机构	1=是;0=否
工作单位的级别	1=省级;2=地/市级;3=县级;4=乡镇及以下
结核病相关工作年限	1=≤1年;2=2~5年;3=6~10年;4=11~20年;5=≥21年

基本特征	调查人数 (名)	参与人数 (名)	参与率 (%)
单位类型
综合医院	2935	1656	56.42
结核病专科医院或防治所	260	224	86.15
疾控中心	826	531	64.29
基层医疗机构	8625	4165	48.29
其他工作单位类型	530	309	58.30
单位是否是结核病定点医疗机构
是	4189	2894	69.09
否	8987	3991	44.41
工作年限(年)
≤1	4520	1355	29.98
2~5	3435	1977	57.55
6~10	2086	1313	62.94
11~20	1684	1179	70.01
≥21	1451	1061	73.12
合计	13176	6885	52.25