Extreme condition, extreme measures? Compliance, drug resistance, and the control of tuberculosis.
Extreme condition, extreme measures? Compliance, drug resistance, and the control of tuberculosis.
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DOI：
10.1080/13648470.2010.493606
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发表时间：
2010-08-01
影响因子：
1.8
通讯作者：
Harper, Ian
中科院分区：
文献类型：
--
作者：
Harper, Ian
本文重点探讨结核病控制的依从性问题。在过去的十年中，结核病控制中的患者依从性已从“直接观察”治疗转向更加以患者为中心的关注和支持，在处理医疗保健服务时采用基于权利的方法。与此同时，国际社会越来越关注耐药结核病的增加以及如何应对这一问题。本文通过讨论围绕这两个问题的话语转变以及它们之间的关系，着眼于这些问题以及它们之间的紧张关系。借鉴尼泊尔的工作经验及其成功的结核病控制计划，本文探讨了围绕这一问题的辩论以及如何解决这两个领域的问题。越来越多的耐药结核病的出现，刺激了世界卫生组织和其他解决这一问题的新指南的制定。介绍了公共卫生、道德和法律授权之间的联系，以及其对控制耐药疾病传播的影响，以及另一方面推动建立更强大的患者支持机制。展望不确定的道德和公共卫生未来，这些问题将由新兴的世界卫生组织和国际框架来调解。
This paper explores the issue of compliance by focusing on the control of tuberculosis. In the last ten years, patient compliance in tuberculosis control has discursively shifted from 'direct observation' of therapy to more patient-centred focus and support drawing on rights-based approaches in dealing with health care provision. At the same time, there has been an increased international concern with the rise of drug resistant forms of tuberculosis, and how to manage this. This paper looks at these issues and the tensions between them, by discussing the shift in discourses around the two and how they relate. Drawing on experience from work in Nepal, and its successful tuberculosis control programme, it looks at debates around this and how these two arenas have been addressed. The rise of increasingly drug resistant forms of tuberculosis has stimulated the development of new WHO and other guidelines addressing how to deal with this problem. The links between public health, ethics and legal mandate are presented, and the implications of this for controlling transmission of drug resistant disease, on the one hand, and the drive for greater patient support mechanisms on the other. Looking forwards to uncertain ethical and public health futures, these issues will be mediated by emergent WHO and international frameworks.