11 YEARS OF COMMUNITY-BASED DIRECTLY OBSERVED THERAPY FOR TUBERCULOSIS
11 YEARS OF COMMUNITY-BASED DIRECTLY OBSERVED THERAPY FOR TUBERCULOSIS
复制标题
DOI：
10.1001/jama.274.12.945
复制
发表时间：
1995-09-27
影响因子：
120.7
通讯作者：
CHAISSON, RE
中科院分区：
文献类型：
--
作者：
CHAULK, CP;MOORERICE, K;CHAISSON, RE
目标。目的：评价社区直接观察治疗（DOT）对结核病（TB）控制的作用。生态study.Methods。在这个描述性研究中进行了三个比较。(1)对马里兰州巴尔的摩市的结核病病例率、痰转换率（SCRs）、治疗完成率和混杂因素（获得性免疫缺陷综合征[艾滋病]、移民、失业和贫困）与1981年结核病发病率最高但没有全面DOT计划的美国五个主要城市进行了11年的回顾性比较。(2) 1981年巴尔的摩市和美国19个主要结核病高发城市11年结核病趋势。(3) 1985 - 1992年两个城市结核病的7年趋势。- 20个居民超过25万的美国大都市。-自1981年以来，巴尔的摩市结核病发病率下降幅度最大（1981年为35.6例/ 10万人口；1992年为17.2例/ 10万人口[-51.7%]），结核病发病率排名城市（1981年第6位，1992年第28位）。相反，在5个城市队列中，结核病的平均发病率增加了2.1%，在19个城市队列中增加了1.8%。自1985年以来，结核病发病率在5个城市队列中增加了35.3%，在19个城市队列中增加了28.5%，但在巴尔的摩下降了29.5%。从1986年到1992年，巴尔的摩的dot管理病例在3个月时的年scr最高（平均为90.7%），标准抗结核治疗的完成率最高（平均为90.1%），与5个城市相比，这些趋势不能归因于艾滋病，移民，贫困或失业的差异。随着时间的推移，越来越多的巴尔的摩病例接受DOT治疗（86.5%，1993年）。疾病复发率仍然很低，即使在hiv感染患者中也是如此。在巴尔的摩，记录在案的SCR在dot管理的病例中明显高于非dot管理的病例
Objective.-To evaluate community-based directly observed therapy (DOT) for tuberculosis (TB) control.Design.-Ecological study.Methods.-Three comparisons were made in this descriptive study. (1) An 11-year retrospective comparison of TB case rates, sputum conversion rates (SCRs), rates of therapy completion, and confounding factors (acquired immunodeficiency syndrome [AIDS], immigration, unemployment, and poverty) in Baltimore, Md, with those of the five major US cities having the highest TB incidence in 1981 but which did not have comprehensive DOT programs. (2) An 11-year trend of TB in Baltimore and the 19 major US cities with the highest TB incidence in 1981. (3) A 7-year trend in TB in both city groups between 1985 and 1992.Setting.-Twenty US metropolitan cities with more than 250 000 residents.Results.-Since 1981, Baltimore experienced the greatest decline in TB incidence (35.6 cases per 100 000 population, 1981; 17.2 cases per 100 000 population, 1992 [-51.7%]), and city rank for TB (sixth in 1981, 28th in 1992). Conversely, the average incidence of TB increased 2.1% in the five-city cohort and increased 1.8% in the 19-city cohort. Since 1985, TB incidence increased 35.3% in the five-city cohort and 28.5% in the 19-city cohort, but declined 29.5% in Baltimore, From 1986 through 1992, Baltimore's DOT-managed cases had the highest annual SCRs at 3 months (mean, 90.7%), and the highest completion rates for standard anti-TB therapy (mean, 90.1%) when compared with the five cities, These trends could not be attributed to differentials in AIDS, immigration, poverty, or unemployment. Increasingly, more Baltimore cases were treated under DOT (86.5%, 1993) over time. Disease relapse rates remained low, even among HIV-infected patients, Within Baltimore, the documented SCR was significantly higher among DOT-managed cases compared with non-DOT-managed cases (P