Integrating tuberculosis and antimicrobial resistance control programmes.
Integrating tuberculosis and antimicrobial resistance control programmes.
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DOI：
10.2471/blt.17.198614
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发表时间：
2018-03-01
影响因子：
11.1
通讯作者：
Khan M
中科院分区：
文献类型：
--
作者：
Hasan R;Shakoor S;Hanefeld J;Khan M
许多低收入和中等收入国家面临高水平的抗菌素耐药性，以及因治疗无效而导致的相关发病率，也有很高的结核病负担。近几十年来，许多国家发展了有效的结核病控制实验室和信息系统。在这篇文章中，我们描述了如何扩展现有的结核病实验室系统以适应抗菌素耐药功能。我们展示了这种服务的扩展如何通过整合实验室服务而使结核病病例发现和实验室能力受益。我们进一步总结了结核病高级别战略和抗菌素耐药性控制之间的协同作用。这些方案提供了一个整合方案的潜在平台，并说明了在中低收入环境下，如何在保健服务提供一级整合诊断服务。在加速扩大诊断检测以合理使用抗微生物药物以及最佳利用资源和分享经验方面，一体化存在许多潜在的互惠互利。然而，将垂直疾病规划与单独的资金流相结合并非没有挑战，我们还讨论了整合的障碍，并确定了克服这些障碍的机会和激励措施。
Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services. We further summarize the synergies between high-level strategies on tuberculosis and antimicrobial resistance control. These provide a potential platform for the integration of programmes and illustrate how integration at the health-service delivery level for diagnostic services could occur in practice in a low- and middle-income setting. Many potential mutual benefits of integration exist, in terms of accelerated scale-up of diagnostic testing towards rational use of antimicrobial drugs as well as optimal use of resources and sharing of experience. Integration of vertical disease programmes with separate funding streams is not without challenges, however, and we also discuss barriers to integration and identify opportunities and incentives to overcome these.