Finding the Missing Tuberculosis Patients
Finding the Missing Tuberculosis Patients
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DOI：
10.1093/infdis/jix368
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发表时间：
2017-10-01
影响因子：
6.4
通讯作者：
Hanson, Christy L.
中科院分区：
文献类型：
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作者：
Chin, Daniel P.;Hanson, Christy L.
结核病控制的许多关键原则都归功于荷兰流行病学家Karel Styblo的工作。Styblo在坦桑尼亚工作，开发了一套登记系统，以获取接受结核病评估的患者信息，然后使用登记系统监测和评估早期结核病控制项目的绩效[1]。鉴于他的方法的成功，Styblo推广了使用队列分析来评估治疗结果。在队列分析中，对开始治疗的每例患者进行统计并分配治疗结局。这与通过排除未能完成治疗的患者而使治疗结果报告产生偏差的常见趋势相反。尽管队列分析目前被国家结核病规划（NTP）广泛使用，但它并不能获取社区中每个结核病患者的结核病治疗信息。传统的队列分析仅包含向NTP报告的患者的治疗结果;因此，未捕获接受治疗但未向NTP报告的TB患者的治疗结果。例如，2013年印度尼西亚全国结核病流行率调查表明，三分之二接受治疗的结核病患者没有向NTP报告[2]。由于那些在NTP之外接受治疗的人通常治疗效果较差，因此排除这些病例的队列分析高估了社区结核病治疗的有效性。在许多国家，结核病流行病例与报告病例的比率很高，这表明确实有许多未报告的结核病病例[3]。除了治疗之外，队列分析的原则可以更广泛地应用于结核病护理和预防的其他方面。同样重要的是，利用队列分析的严谨性和彻底性来评价结核病诊断过程及其与治疗的联系。随着全球社会努力结束结核病流行，最紧迫的挑战是每年超过400万结核病患者-占所有事件病例的40%-未向NTP报告[3]。这些“失踪”的患者要么未被诊断，要么被诊断但未报告。我们应该优先找到这些病人
Many of the key principles of tuberculosis (TB) control are credited to the work of Karel Styblo, the Dutch epidemiologist. Working in Tanzania, Styblo developed a set of registries to capture information on patients evaluated for TB and then used the registries to monitor and evaluate the performance of early TB control programs [1]. Given the success of his approach, Styblo popularized the use of the cohort analysis to evaluate treatment outcomes. In a cohort analysis, every patient started on treatment is accounted for and assigned a treatment outcome. This countered the common tendency to bias the reporting of treatment outcomes by excluding patients who failed to complete treatment.Although the cohort analysis is widely used by national TB programs (NTPs) today, it does not capture information on TB treatment for every TB patient in a community. The traditional cohort analysis only contains treatment results for patients who are reported to the NTP; thus, the treatment outcomes of TB patients who are treated but not reported to the NTP are not captured. For example, the 2013 Indonesian national TB prevalence survey indicated that two-thirds of treated TB patients were not reported to the NTP [2]. Because those treated outside of the NTP generally have poorer treatment outcomes, a cohort analysis that excludes these cases overestimates the effectiveness of TB treatment in a community. In many countries, there is a high ratio of prevalent to notified TB cases, which suggests that there are, indeed, many unreported TB cases [3]. Beyond treatment, the principles of a cohort analysis can be applied more broadly to other aspects of TB care and prevention. It is equally important to use the rigor and thoroughness of a cohort analysis to evaluate the TB diagnostic process and the linkage to treatment. As the global community works to end the TB epidemic, the most pressing challenge is that> 4 million TB patients each year—40% of all incident cases—are not reported to NTPs [3]. These “missing” patients are either undiagnosed or are diagnosed but not reported. We should prioritize finding these patients