Has the DOTS strategy improved case finding or treatment success? An empirical assessment.
Has the DOTS strategy improved case finding or treatment success? An empirical assessment.
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DOI：
10.1371/journal.pone.0001721
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发表时间：
2008-03-05
期刊：
影响因子：
3.7
通讯作者：
Murray CJ
中科院分区：
文献类型：
--
作者：
Obermeyer Z;Abbott-Klafter J;Murray CJ
在世卫组织DOTS战略开始近15年后，结核病仍然是一个主要的全球卫生问题。由于缺乏DOTS减少结核病负担的经验证据，关于其在未来全球结核病控制工作中的地位引起了相当大的争论。对DOTS这一全球卫生领域实施最广泛、持续时间最长的干预措施之一进行独立评价，是切实改进结核病控制工作，包括世卫组织新的遏制结核病战略的先决条件。我们仅使用经验数据调查DOTS策略的扩展对结核病病例发现和治疗成功的影响。我们使用时间序列横截面方法研究DOTS的效果。我们首先估计DOTS扩展对病例发现的影响，使用报告的病例通知数据并控制通知变化的其他决定因素，包括艾滋病毒流行率，GDP和国家特定影响。然后，我们估计DOTS扩展对治疗成功的影响。DOTS方案变量在广泛的模型和规范中对病例检出率没有统计学显著影响。DOTS人口覆盖率对总体治疗成功率有显着影响，因此，DOTS完全覆盖的国家受益于治疗成功率至少增加18%（95%CI：5-31%）。DOTS技术包提高了整体治疗成功率。相比之下，DOTS扩展对病例发现没有影响。这一发现不如以前的分析乐观。更好的流行病学和方案数据将有助于今后的监测和评价工作。
Nearly fifteen years after the start of WHO's DOTS strategy, tuberculosis remains a major global health problem. Given the lack of empirical evidence that DOTS reduces tuberculosis burden, considerable debate has arisen about its place in the future of global tuberculosis control efforts. An independent evaluation of DOTS, one of the most widely-implemented and longest-running interventions in global health, is a prerequisite for meaningful improvements to tuberculosis control efforts, including WHO's new Stop TB Strategy. We investigate the impact of the expansion of the DOTS strategy on tuberculosis case finding and treatment success, using only empirical data. We study the effect of DOTS using time-series cross-sectional methods. We first estimate the impact of DOTS expansion on case detection, using reported case notification data and controlling for other determinants of change in notifications, including HIV prevalence, GDP, and country-specific effects. We then estimate the effect of DOTS expansion on treatment success. DOTS programme variables had no statistically significant impact on case detection in a wide range of models and specifications. DOTS population coverage had a significant effect on overall treatment success rates, such that countries with full DOTS coverage benefit from at least an 18% increase in treatment success (95% CI: 5–31%). The DOTS technical package improved overall treatment success. By contrast, DOTS expansion had no effect on case detection. This finding is less optimistic than previous analyses. Better epidemiological and programme data would facilitate future monitoring and evaluation efforts.
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