What is the limit to case detection under the DOTS strategy for tuberculosis control?
What is the limit to case detection under the DOTS strategy for tuberculosis control?
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DOI：
10.1016/s1472-9792(02)00056-2
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发表时间：
2003-01-01
期刊：
影响因子：
3.2
通讯作者：
Williams, BG
中科院分区：
文献类型：
--
作者：
Dye, C;Watt, CJ;Williams, BG
2000年，世界卫生组织的DOTS结核病控制战略已被212个国家中的148个国家采用，但在该年，只有27%的估计痰涂片阳性患者在DOTS下得到通报。在这里，我们调查的方式，在DOTS下的情况下，检测的收益，直到2000年，试图预测未来的进展，对全球目标的70%的情况下检测。该分析借鉴了DOTS地理覆盖和病例通知的年度报告，并侧重于22个高负担国家（HBCs），这些国家占全球每年新发结核病例的80%左右。我们的主要观察结果是，随着22个负担沉重国家的结核病规划在地理上的扩大，在指定的DOTS地区发现的痰涂片阳性病例估计数的比例保持在40-50%，尽管各国之间存在显著差异。这一比例与每年通过全世界公共卫生系统向世卫组织通报的所有痰检阳性病例的百分比大致相同。这意味着，除非DOTS战略能够超越传统的公共卫生报告系统，或者除非这些系统能够得到改进，否则，即使DOTS的地理覆盖率名义上是100%，22个负担沉重国家或全世界的病例发现率也不会超过40%。我们估计，在DOTS全面覆盖的情况下，四分之三未发现的涂阳病例将生活在印度、中国、印度尼西亚、尼日利亚、孟加拉国和巴基斯坦。但在人口较少的国家，病例发现率也可能保持在较低水平：2000年，超过一半的涂阳结核病例居住在49个国家，这些国家在DOTS地区发现的病例不到40%。因此，需要作出重大努力：（a）开发新的病例发现和管理方法，以弥补当前病例和目标病例发现之间的差距;（B）提高国家结核病发病率估计的准确性，尤其是通过加强和扩大常规监测。(C)2003爱思唯尔科技有限公司版权所有。
In year 2000, the WHO DOTS strategy for tuberculosis (TB) control had been adopted by 148 out of 212 countries, but only 27% of all estimated sputum smear-positive patients were notified under DOTS in that year. Here we investigate the way in which gains in case detection under DOTS were made up until 2000 in an attempt to anticipate future progress towards the global target of 70% case detection. The analysis draws on annual reports of DOTS geographical coverage and case notifications, and focuses on the 22 high-burden countries (HBCs) that account for about 80% of new TB cases arising globally each year. Our principal observation is that, as TB programmes in the 22 HBCs have expanded geographically, the fraction of the estimated number of sputum smear-positive cases detected within designated DOTS areas has remained constant at 40-50% although there are significant differences between countries. This fraction is about the same as the percentage of all smear-positive cases notified annually to WHO via public health systems worldwide. The implication is that, unless the DOTS strategy can reach beyond traditional public health reporting systems, or unless these systems can be improved, case detection will not rise much above 40% in the 22 HBCs, or in the world as a whole, even when the geographical coverage of DOTS is nominally 100%. We estimate that, under full DOTS coverage, three-quarters of the undetected smear-positive cases will be living in India, China, Indonesia, Nigeria, Bangladesh and Pakistan. But case detection could also remain tow in countries with smaller populations: in year 2000, over half of all smear-positive TB cases were living in 49 countries that detected less than 40% of cases within DOTS areas. Substantial efforts are therefore needed (a) to develop new case finding and management methods to bridge the gap between current and target case detection, and (b) to improve the accuracy of national estimates of TB incidence, above all by reinforcing and expanding routine surveillance. (C) 2003 Elsevier Science Ltd. All rights reserved.