Evaluating the potential impact of the new Global Plan to Stop TB: Thailand, 2004-2005
Evaluating the potential impact of the new Global Plan to Stop TB: Thailand, 2004-2005
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DOI：
10.2471/blt.06.038067
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发表时间：
2007-08-01
期刊：
影响因子：
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通讯作者：
Tappero, Jordan W
中科院分区：
文献类型：
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作者：
Varma, Jay K;Wiriyakitjar, Daranee;Tappero, Jordan W
世卫组织新的2006-2015年遏制结核病全球计划建议结核病高负担国家扩大私营部门的病例发现以及为艾滋病毒和耐多药结核病患者提供的服务。本研究的目的是利用泰国结核病主动监测网络（2004年开始的一个示范项目）的数据对泰国的这些战略进行评估。方法2004年10月，我们开始每月联系公立和私立卫生保健机构，记录结核病确诊患者的数据，协助患者护理，提供艾滋病毒咨询和检测，并获取痰样本进行培养和药敏试验。该流域包括四个省的360万人口。我们将2004年10月至2005年9月（简称2005年）的结果与2002年10月至2003年9月（简称2003年）的基线数据进行了比较。结果2005年确诊结核病例5841例（164/10万），其中新发涂片阳性病例2320例（65/10万）。与2003年的常规被动监测相比，主动监测使所有结核病例的报告率提高了19%，使痰检阳性新发病例的报告率提高了13%。私立机构诊断了634例（11%）结核病例。2005年，已知有1392例（24%）艾滋病毒阳性。艾滋病毒感染状况不明的病例比例从2003年的66%（3226/4904）下降到2005年的23% (1329/5841)（P < 0.01）。在4656例肺部病例中，3024例（65%）进行了分枝杆菌培养，60例（1%）诊断为耐多药结核病。在泰国，试行世卫组织新战略增加了病例发现和与私营部门的合作，并改善了针对结核病患者的艾滋病毒服务和耐多药结核病的诊断。需要进一步分析治疗结果和费用，以评估该规划的影响和成本效益。
Objective WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB). The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004.Methods In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing. The catchment area included 3.6 million people in four provinces. We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003).Findings In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000). Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%. Private facilities diagnosed 634 (11 %) of all TB cases. In 2005, 1392 (24%) cases were known to be HIV positive. The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 (P < 0,01). Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1 %).Conclusion In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB. Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness.