Impact of joined-up HIV harm reduction and multidrug resistant tuberculosis control programmes in Estonia: System dynamics simulation model
Impact of joined-up HIV harm reduction and multidrug resistant tuberculosis control programmes in Estonia: System dynamics simulation model
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DOI：
10.1016/j.healthpol.2006.05.021
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发表时间：
2007-05-01
期刊：
影响因子：
3.3
通讯作者：
Coker, Richard J.
中科院分区：
文献类型：
--
作者：
Atun, Rifat A.;Lebcir, Reda M.;Coker, Richard J.
在东欧和中亚（非洲经委会），结核病、耐多药结核病和人类免疫缺陷病毒（艾滋病毒）的控制构成了重要的公共卫生挑战。我们使用系统动力学模拟来确定20年来对艾滋病毒/艾滋病、结核病和艾滋病毒相关结核病死亡的累积影响，在艾滋病毒在注射吸毒者中呈爆炸性流行和耐多药结核病发病率高的人群中，实施减少伤害方案，以减少注射吸毒者共用针头和注射频率，并控制耐多药结核病。如果实施有效的减少危害方案，死亡人数将减少30%，但如果这些方案无效，死亡人数将增加一倍。在我们的模型中，有效的耐多药结核病和艾滋病毒控制将累计结核病死亡减少54%，累计耐多药结核病死亡减少15倍，累计艾滋病毒相关结核病死亡减少2倍。有效的耐多药结核病控制，如果没有有效的减少危害计划，只能将结核病死亡人数减少22%。然而，有效的减少危害方案以及对耐多药结核病控制不力的方案使结核病累计死亡人数减少了34%，耐多药结核病减少了14%，艾滋病毒相关结核病减少了56%。即使有良好的药物敏感性结核病控制方案，忽视减少危害和耐多药结核病控制将导致结核病相关死亡人数比有效解决这两个问题高出50%。有效的减害方案比有效的耐多药结核病控制更能实质性地减少结核病的累积死亡人数。我们的发现对后苏联国家的传染病政策具有重要的政策意义，如果要有效地解决新出现的艾滋病毒和耐多药结核病流行病，这些政策需要进行重大改变。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
In Eastern Europe and Central Asia (ECA) the control of tuberculosis, multidrug resistant tuberculosis (MDRTB) and human immunodeficiency virus (HIV) poses important public health challenges. We used system dynamics simulation to determine impact on cumulative HIV/AIDS, tuberculosis and HIV-associated-tuberculosis deaths, over 20 years, of harm-reduction programmes to reduce needle-sharing and injection-frequency amongst injecting drug users (IDUs) and multidrug resistant tuberculosis (MDRTB) control in a population with an explosive HIV epidemic in IDUs and high MDRTB prevalence.We estimate that the number of HIV-associated-deaths will decline by 30% with effective harm-reduction programmes but double if these are ineffective. In our model, effective MDRTB and HIV control reduces cumulative tuberculosis deaths by 54%, cumulative MDRTB deaths 15-fold and cumulative HIV-associated-tuberculosis-deaths 2-fold. Effective MDRTB control, without effective harm-reduction programmes, only reduce tuberculosis deaths by 22%. However, effective harm-reduction programme with a poor MDRTB control reduce cumulative tuberculosis deaths by 34%, MDRTB by 14% and HIV-associated-tuberculosis by 56%. Even with good control programmes for drug sensitive TB, neglecting harm reduction and MDRTB control will result in 50% more tuberculosis-related deaths than if both are effectively addressed. Effective harm-reduction programmes reduces cumulative deaths from tuberculosis more substantively than effective MDRTB control.Our finding have important policy implications for communicable disease policies in post-Soviet countries, which need to substantially change if they are to effectively address the emerging HIV and MDRTB epidemics. (c) 2006 Elsevier Ireland Ltd. All rights reserved.