Prospects for worldwide tuberculosis control under the WHO DOTS strategy
Prospects for worldwide tuberculosis control under the WHO DOTS strategy
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DOI：
10.1016/s0140-6736(98)03199-7
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发表时间：
1998-12-12
期刊：
影响因子：
168.9
通讯作者：
Williams, BG
中科院分区：
文献类型：
--
作者：
Dye, C;Garnett, GP;Williams, BG
背景世界卫生组织提倡使用直接观察治疗与短程药物方案作为DOTS战略的一部分，但这种战略在世界范围内的潜在效果尚未调查。并预测改进病例发现和治愈在世卫组织六个区域中的每一个区域对结核病流行的影响。如果没有HIV-1，达到70%病例发现和85%治愈的世卫组织目标的控制规划将使发病率每年降低11%（范围8-12），死亡率每年降低12%（9-13）。如果结核病已经下降了几年，同样的病例发现率和治愈率对发病率的影响就较小。DOTS挽救的死亡比例高于病例，在HIV-1存在的情况下，这种差异更大。艾滋病毒-1的流行导致结核病发病率增加，但并没有大幅度减少可预防的病例和死亡比例。如果不加大力度控制结核病，预计1998年至2020年间该疾病的年发病率将增加41%（21-61）（从每年740万例增加到1060万例）。到2010年实现世卫组织的目标，到2020年将预防23%（15-30）或4800万例病例。解释化疗（以DOTS形式提供）对结核病的潜在影响现在在许多发展中国家比50年前在发达国家更大。为了利用这一潜力，迫切需要提高主要流行地区的病例发现率和治愈率。
Background WHO advocates the use of directly observed treatment with a short-course drug regimen as part of the DOTS strategy, but the potential effect of this strategy worldwide has not been investigated.Methods We developed an age-structured mathematical model to explore the characteristics of tuberculosis control under DOTS, and to forecast the effect of improved case finding and cure on tuberculosis epidemics for each of the six WHO regions.Findings In countries where the incidence of tuberculosis is stable and HIV-1 absent, a control programme that reaches the WHO targets of 70% case detection and 85% cure would reduce the incidence rate by 11% (range 8-12) per year and the death rate by 12% (9-13) per year. If tuberculosis has been in decline for some years, the same case detection and cure rates would have a smaller effect on incidence. DOTS saves a greater proportion of deaths than cases, and this difference is bigger in the presence of HIV-1. HIV-1 epidemics cause an increase in tuberculosis incidence, but do not substantially reduce the preventable proportion of cases and deaths. Without greater effort to control tuberculosis, the annual incidence of the disease is expected to increase by 41% (21-61) between 1998 and 2020 (from 7.4 million to 10.6 million cases per year). Achievement of WHO targets by 2010 would prevent 23% (15-30) or 48 million cases by 2020.Interpretation The potential effect of chemotherapy (delivered as DOTS) on tuberculosis is greater in many developing countries now than it was in developed countries 50 years ago. To exploit this potential, case detection and cure rates urgently need to be improved in the main endemic areas.