Tuberculosis control in resource-poor countries: have we reached the limits of the universal paradigm?
Tuberculosis control in resource-poor countries: have we reached the limits of the universal paradigm?
复制标题
DOI：
10.1111/j.1365-3156.2004.01273.x
复制
发表时间：
2004-07-01
影响因子：
3.3
通讯作者：
Ogden, JA
中科院分区：
文献类型：
--
作者：
Lienhardt, C;Ogden, JA
结核病控制的目的是通过尽早和尽可能有效地治疗结核病病例来打破传播循环。在努力促进全球结核病控制模式的过程中，世卫组织确定了具体目标，并启动了“直接观察短程治疗”（DOTS）战略，作为实现这些目标的主要工具。然而，患者对疾病的不同态度和获得护理的极端差异，特别是在资源贫乏的国家，是深刻影响控制规划有效执行这一政策的能力的众多社会背景因素之一。有许多关于结核病控制规划使用各种干预措施来促进依从性和加强病例保存的报告，但这些干预措施大多数依赖外部资金，这使其长期可持续性受到质疑。在本文中，我们讨论了在资源贫乏国家实施DOTS战略时与操作可变性相关的问题，并对全球结核病控制普遍范例的适用性提出了质疑。这一分析尤其重要，因为编程人员考虑在资源有限的环境中使用这一模式提供抗逆转录病毒疗法来治疗艾滋病毒。
The aim of TB control is to break the cycle of transmission by treating TB cases as early and efficiently as possible. In its efforts to promote a model of worldwide TB control, WHO defined specific targets and launched the 'Directly Observed Therapy, Short-course' (DOTS) strategy as the main tool to reach them. However, the diversity of patients' attitudes towards the disease and the extreme variability of access to care, especially in resource-poor countries, are amongst the many factors of social context that profoundly affect the ability of control programmes to implement this policy effectively. There are multiple reports of TB control programmes using various types of intervention to promote adherence and enhance case-holding, but most of these interventions depend on external funding, which bring into question their long-term sustainability. In this paper, we address the problems related to operational variabilities in the implementation of the DOTS strategy in resource-poor countries and question the appropriateness of a universal paradigm for global TB control. This analysis is of particular importance as programmers consider using this model in the delivery of anti-retroviral therapies for the treatment of HIV in resource-limited settings.