2004-2010年广西宜州市结核病疫情分析

目的 了解2004- 2010年广西宜州市结核病疫情及现代结核病防治策略(Directly Observed Treatment,Short- Course (DOTS))实施情况,为当地下一步结核病防治提供参考.方法 收集宜州市各乡镇2004-2010年结核病控制疫情数据,采用Excel软件进行统计分析.结果 2004- 2010年共发现结核病患者7 026例,患病率维持在90.42/10万～197.95/10万之间,平均为158.89/10万.患者男女性别比例为2.27:1.结核病患者中农民比例最高占77.71％,其次为家政、家务及待业人员占5.61％,公职人员占5.02％.患者多集中在中老年人群,随年龄的增长患者数量增多,65 ～74岁年龄组患者达到高峰,35岁以上患者占总病例82％.结核涂阳患者治愈率年平均为88.85％,结核及非结核死亡人数分别为22例和17例.各乡镇均有结核病例分布,流动人口结核患者占总病例数最多为22.90％.结论 宜州市结核病患者以中老年人群为主,主要集中在农村人群中,其结核病的防治任务仍然十分艰巨.     

2002-2012年广西壮族自治区宜州市结核病防治效果分析

目的 分析广西壮族自治区宜州市结核病防治效果,为下一步开展结核病防治工作提供参考.方法 收集2002-2012年广西宜州市初诊病人登记本、结核病患者登记本以及月报表、季度报表数据,用Excel软件进行统计分析.结果 2002-2012年共发现结核病患者9 720例,患病率年平均为131.17/10万,患者男女性别比例为2.32∶1,农民患病率最高(78.36％),患者主要集中在中老年人群,35～74岁年龄组占72.91％,涂阳患者治愈率年平均为88.7％.结论 宜州市积极开展现代结核病控制策略,通过加强结核病知识的宣传,加强直接督导短程化疗(DOTS)的管理措施,使结核病患者的发现率和治愈率得到显著提高.     

2004-2009年巴马瑶族自治县结核病流行病学调查结果分析

目的了解DOTS策略在少数民族县实施情况及效果,为当地今后结核病防治提供参考。方法收集巴马县2004-2009年结核病控制工作季报表,采用Excel软件进行统计分析。结果 2004-2009年当地居民结核病年平均新涂阳患者发病率为38.23/10万,波动在16.22～70.36/10万之间;患者男女性别比为2.35:1,农民占比例为78.79%,患者高峰年龄组为25～34岁占19.86%,但女性患者高峰年龄组为15～24岁。2004-2008年新涂阳结核患者治愈率年平均为87.66%。结论当地居民结核患者得到了及时的诊断和正规的治疗,但结核病患者减少不明显,防治任务仍然十分艰巨。     

实施现代结核病控制策略对传染性肺结核患者发现与治疗效果的影响

目的：分析实施DOTS策略对传染性肺结核病例发现与治疗效果的影响。方法：通过对1995—2000年分批实施的卫生部加强与促进结核病控制项目、WHO西太区结核病控制项目及福建省结核病控制项目资料进行分析。结果涂阳病例新登记率由1995年的6．3／10万提高到2000年的19．0／10万，涂片阳性占活动性病例比例由21．5％提高到37．4％，新发涂阳病例治愈率由80．7％提高到89．2％，病例丢失率由7．3％下降到2．7％，治疗失败率由6．9％下降到1．4％。流动人口传染性肺结核病例治愈率仅59．7％。结论：实施DOTS策略，重视流动人口结核病治疗管理，提高涂阳病例发现率、治愈率，减少病例丢失和治疗失败，有效控制结核病。     

2005-2009年隆林各族自治县结核病流行病学调查结果分析

目的了解DOTS策略在少数民族县实施情况及效果,为当地下一步结核病防治提供参考。方法收集隆林县2004-2009年结核病控制工作季度报表,采用Excel软件进行统计分析。结果 2004-2009年当地居民结核病涂阳患病率维持在42.07～31.11/10万之间;患者男女性别比为1.83:1,农民占比例为86.16%,发病年龄组最多是15～24岁占总病例的24.01%;结核涂阳患者治愈率年平均为85.10%。结论当地居民结核患者得到了及时的诊断和正规的治疗,但结核患病率下降趋势不明显,防治任务仍然十分艰巨。     

2004-2009年靖西县结核病流行病学分析

目的了解督导短程化疗（DOTS）策略在少数民族边境县实施情况及效果,为当地下一步结核病防治提供参考。方法收集靖西县2004--2009年结核病控制工作季度报表,采用描述性流行病学方法进行分析,对所收集的资料按年龄组、性别、职业和治疗情况等进行分类,并采用Excel软件进行统计分析：结果2004--2009年当地居民共发现结核病患者2896例,其中涂阳患者969例。结核病惠病率维持在54．75／10万-107．10／10万之间。男性2025例,女性871例,男女性别比为2．32：1;发病年龄集中在15～54岁年龄组,占76．66％（2220／2896）;农民及民工所占比例为90．75％（2628／2896）：涂阳患者治愈率年平均为86．27％（836／969）。结论靖西县当地居民结核病患者以青壮年农民及民工为主,涂阳患者治愈率明显提高,但结核病患病率下降趋势不明显．防治任务仍然十分艰巨：     

2004—2009年靖西县结核病流行病学分析

目的了解督导短程化疗(DOTS)策略在少数民族边境县实施情况及效果,为当地下一步结核病防治提供参考。方法收集靖西县2004—2009年结核病控制工作季度报表,采用描述性流行病学方法进行分析,对所收集的资料按年龄组、性别、职业和治疗情况等进行分类,并采用Excel软件进行统计分析。结果 2004—2009年当地居民共发现结核病患者2 896例,其中涂阳患者969例,结核病患病率维持在54.75/10万～107.10/10万之间。男性2 025例,女性871例,男女性别比为2.32∶1;发病年龄集中在15～54岁年龄组,占76.66%(2 220/2 896);农民及民工所占比例为90.75%(2 628/2 896)。涂阳患者治愈率年平均为86.27%(836/969)。结论靖西县当地居民结核病患者以青壮年农民及民工为主,涂阳患者治愈率明显提高,但结核病患病率下降趋势不明显,防治任务仍然十分艰巨。     

文山州八个国家级贫困县实施国家结核病控制规划效果及面临的挑战

[目的]探讨文山州八个贫困县实施国家结核病控制规划（NTP）取得的成绩和在新的领域所面临的挑战。[方法]①分析文山州八个贫困县实施结核病控制DOTS（现代结核病控制策略）覆盖后结核病控制效果;②分析文山州结核病流行病学时空变化趋势与结核病控制可持续发展面临的新挑战。[结果]①文山州2004年实现了以县为单位,DOTS策略人口覆盖率100％。②实施DOTS覆盖和DOTS扩展后,活动性肺结核、涂阳肺结核、新发涂阳肺结核登记率分别为70．8／10万、31．9／10万、26．9／10万。③新涂阳病人发现率52．7％、涂阳病人治愈率94．2％、涂阳病人成功治疗率94．6％。④2010年流调活动性肺结核患病率分别较1979年流调上升5．3倍、较1990年流调上升5．2倍;较2000年流调上升2．3倍。[结论]①实施DOTS覆盖推动文山州八个贫困县取得了活动性肺结核高发现率,涂阳肺结核高治愈率、低治疗失败率和低治疗丢失率效果,完成了规划核心指标。②本地区结核病高患病率状况还未改变,结核病疫情依然严峻,结核病高患病率的流行病学关联还有待进一步研究。③结核病控制可持续发展面临着专业人员缺乏、结防机构能力薄弱、资金匮乏、结核艾滋（TB／HIV）双重感染及传染源低披现率等新的挑战。     

2011-2015年广东省汕头市结核病流行病学特征及DOTS策略评价

目的分析广东省汕头市结核病流行病学特征并通过结核病传染参数对非住院肺结核患者实行全面监督化学治疗(directly observed treatment short-course,DOTS)策略的实施进行评价。方法利用《疾病监测信息报告管理系统》及《结核病信息管理系统》中2011-2015年数据对广东省汕头市结核病患者进行流行病学特征分析,计算获得汕头市结核病传染参数并对该地区DOTS策略的实施进行评价。结果 2011-2015年汕头市肺结核登记率为63.59/10万,涂阳肺结核登记率为38.48/10万,二者均逐年降低;每年汕头男性肺结核、涂阳肺结核患者人数约占总数的3/4左右,五年内性别分布差异无统计学意义(P0.05),年龄分布多集中于青年及老年,冬季报告人数高于其他三个季度,肺结核患者主要分布在潮阳区(30%)和金平区(26%),涂阳肺结核患者主要分布在潮南区(28%)和澄海区(28%)。职业分布主要为农民(50%左右)。2011-2015年汕头市结核病患者的地区分布主要为潮阳区(30%)和金平区(25%),涂阳患者主要分布在潮南区(28%)和澄海区(27%)。DOTS策略评价结果表明该地区近五年传染参数平均值为3.8,并呈现逐年下降趋势。结论 DOTS策略在广东省汕头市有力实施,结核病在该地区受到有效控制。     

DOTS策略下深圳市结核病疫情控制效果分析

目的探讨DOTS策略下肺结核病人管冶效果及疫情变化趋势。方法收集1993～2003年深圳市实施DOTS策略中结核病防治有关资料，以及流行病学调查资料，并进行描述性分析。结果从1993年至2003年，登记涂阳肺结核8483例，治愈率96，3％。肺结核疫情明显下降，深圳市户籍人口涂阳患病率下降55．9％，非户籍人口涂阳患病率下降38，6％。结论DOTS作为现代结核病控制策略是深圳市结核病疫情有效控制的基础。     

Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India

OBJECTIVE: To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. METHODS: We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants. Effectiveness was measured as the number of cases successfully treated. FINDINGS: The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector. From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63). DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS). The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment. Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs. CONCLUSION: PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients.     

Low access to a highly effective therapy: a challenge for international tuberculosis control

OBJECTIVE: To determine the scale of the tuberculosis (TB) problem facing the international Stop TB Partnership by measuring the gap between present rates of case detection and treatment success, and the global targets (70% and 85%, respectively) to be reached by 2005 under the WHO DOTS strategy. METHODS: We analysed case notifications submitted annually to WHO from up to 202 (of 210) countries and territories between 1980 and 2000, and the results of treatment for patients registered between 1994 and 1999. FINDINGS: Many of the 148 national DOTS programmes in existence by the end of 2000 have shown that they can achieve high treatment success rates, close to or exceeding the target of 85%. However, we estimate that only 27% of all the new smear-positive cases that arose in 2000 were notified under DOTS, and only 19% were successfully treated. The increment in case-finding has been steady at about 133 000 additional smear-positive cases in each year since 1994. In the interval 1999- 2000, more than half of the extra cases notified under DOTS were in Ethiopia, India, Myanmar, the Philippines, and South Africa. CONCLUSION: With the current rate of progress in DOTS expansion, the target of 70% case detection will not be reached until 2013. To reach this target by 2005, DOTS programmes must find an additional 333 000 cases each year. The challenge now is to show that DOTS expansion in the major endemic countries can significantly accelerate case finding while maintaining high cure rates.     

综合性医院归口诊治肺结核病的改革实践

目的:充分发挥综合医院作用,提高肺结核病人发现率。方法:通过全面推行结核病控制策略(DOTS),改革防制模式,实行以一所综合医院为归口诊治、其他医院机构为归口转诊、疾控中心为归口管理模式,建立转诊制度,明确各自职责和分工。结果:全县传染源发现率平均已达96.7%;新发涂阳肺结核病新登记率从1995年~1999年30.1/10万上升到2000年~2005年44.50/10万,增长了47.8%;转诊率从1995年~1999年82.1%上升到2005年的98.5%,增长了20%。结论:改革后的结核病归口诊治管理模式,利用现有医疗资源,有效提高了肺结核病人的转诊率和涂阳病人的发现率,发挥了综合性医院对结核病控制工作的重要作用。     

丹阳市农村居民肺结核患病率调查结果分析

目的调查丹阳市农村居民肺结核患病率,评估结核病防治效果,并为完善结核病监测体系提供依据。方法 2009年采用整群抽样方法,对调查点常住人口开展入户调查,对肺结核可疑症状者进行胸片和痰涂片检查,确诊肺结核患者进行痰培养。计数资料采用χ2检验,P0.05为差异有统计学意义。结果常住人口筛查93 046人,发现肺结核43例,其中涂片阳性(涂阳)肺结核18例;肺结核患病率为46.2/10万,涂阳患病率为19.4/10万,细菌培养阳性(菌阳)患病率为21.5/10万;男性患病率显著高于女性;患病率曲线呈偏态单峰型,65~75岁组达高峰(182.6/10万),65~75岁患病率与55~65岁、75岁以上患病率差异无统计学意义(P0.05),但与15~25、25~35、35~45、45~55岁对比差异有统计学意义(P0.05);离退、待业和家务人员患病率相对较高;不同文化程度人群间患病率差异无统计学意义(P0.05)。结论丹阳市自2001年以来认真实施结核病全程监督短程化疗策略,本市农村居民活动性肺结核患病率有了明显下降,但中老年人活动性肺结核患病率依然居高不下,成为影响当地肺结核疫情的重要因素。应加强中老年人特别是55岁以上男性中老年人肺结核防治工作,有针对性开展主动筛查,做好早发现早诊断早治疗,对减少肺结核发病和降低结核病患病率具有重要意义。     

Improving tuberculosis case detection rate with a lay informant questionnaire: an experience from the Lao People's Democratic Republic

PROBLEM: In many countries, the tuberculosis (TB) annual case detection rate is below the target of 70%. In the Lao People's Democratic Republic in 2005, it did not exceed 55% APPROACH: The DOTS strategy promotes passive case detection of TB. In order to increase the detection rate, we validated a questionnaire targeting lay informants at village level to notify patients with chronic cough and assessed the relevance for TB case-finding. A three-item questionnaire was sent through the district health departments to all villages in six districts in six provinces. The village headmen were asked to notify chronic cough patients. Answers were validated in a door-to-door survey (20 villages/district). In a sub-sample (four villages/district) all confirmed patients were screened for TB and paragonimiasis. LOCAL SETTING: Attapeu, Luang Namtha, Luang Prabang, Saravane, Savanakhet and Vientiane provinces in the Lao People's Democratic Republic. RELEVANT CHANGES: Lay informant questionnaires sent from district health offices to villages are cost-effective and foster interaction between the health services and remote and underserved communities. Although the correct detection of patients is highly dependent on direct respondents, a substantial number of new TB and paragonimiasis cases were consistently diagnosed in chronic cough patients. LESSONS LEARNED: Out of 456 questionnaires, 295 were returned (65%). Return rates were highly variable between districts (48-87%), questionnaires' sensitivity (56-98%), positive predictive value (34-88%) and correlation between number of notified and confirmed patients (r: 0.26-0.78). In sub-sampled villages (13,541 population) 19 (5.1%) TB and 26 (7.0%) paragonimiasis cases were detected in 374 chronic cough patients. This quick questionnaire approach proved motivating for district authorities and village key informants, although no incentives were provided. The highly operator-dependent approach yielded a consistent detection rate of TB and paragonimiasis cases. This approach brings health services and populations in need in close contact, which is particularly crucial in remote and underserved areas.     

Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province,China: a case control study

Background  

The directly observed therapy-short course (DOTS) strategy was introduced in Shaanxi province, China to improve tuberculosis (TB) control by means of improved case detection (target: > = 70%) and treatment success rates (target: > = 85%) in new smear positive (SS+) TB patients. At a provincial level the targets were both reached in 2005. However in 30 (28%) out of 107 counties of Shaanxi province the cure rate was below 85%. This study aimed to investigate patient and treatment characteristics associated with non-cure after tuberculosis (TB) treatment in these counties.     

The DOTS strategy in China: results and lessons after 10 years

OBJECTIVE: To analyse the five-point tuberculosis (TB) strategy, DOTS, 10 years after its implementation in one-half of China's population, and to suggest lessons for future implementation of the DOTS strategy. METHODS: We analysed trends in case-finding and treatment outcome over time following implementation of the DOTS strategy in each county, using routine reporting data from the Infectious and Endemic Disease Control (IEDC) project (1991 - 2000). We also determined the proportion of counties with different levels of case-finding for the fifth and sixth years of DOTS implementation. FINDINGS: From 1991 to 1995, DOTS expanded rapidly to cover more than 90% of target population and counties. By 2000, 8 million TB suspects had received free diagnostic evaluation: 1.8 million TB cases were diagnosed, free treatment was provided to 1.3 million smear-positive cases, and more than 90% were cured. During DOTS implementation, the percentage of previously treated cases decreased among all smear-positive cases and treatment outcomes improved. Despite these achievements, the detection rate for new smear-positive cases in the project was estimated to be only 54% in 1998, and 41.2% of the counties had a below average or low level of case-finding (with substantial variation between provinces). CONCLUSIONS: The IEDC project demonstrated that it is feasible to rapidly expand DOTS on a large scale. The global target of an 85% cure rate was quickly achieved, and the level of drug-resistance was probably reduced by this project. However, case-detection did not reach the 70% global target, and more research is needed on how to enhance this.     

安徽省2004年实施DOTS策略防治肺结核病效果评价

目的分析安徽省2004年实施肺结核病DOTS防治策略效果,为制定下一步结核病防治工作计划提供技术依据。方法对全省各县级结核病防治机构上报的2004年中国结核病控制工作季报表进行统计,分析实施DOTS效果。结果实施DOTS县(区)的活动性病人登记率、涂阳病人登记率分别是非DOTS县(区)的4.49倍和8.33倍;初、复治病人治愈率分别提高了14.76个百分点和5.36个百分点。结论实施DOTS是结核病防治工作的有效措施。要控制结核病,必需全面实施DOTS策略。     

Reform of tuberculosis control and DOTS within Russian public health systems: an ecological study

OBJECTIVES: To investigate the association between clinical need and hospital bed supply and utilization in Russia; and, to investigate these associations in areas where traditional Russian tuberculosis health care systems exist and where the directly observed therapy-short course (DOTS) strategy has been implemented. DESIGN: Ecological study using 2002 routine data. MAIN OUTCOME MEASURES: Hospital bed utilization and hospital admissions for patients with tuberculosis in regions that adhere to the traditional Russian method of managing tuberculosis and those where the DOTS strategy has been implemented. RESULTS: The ratio of beds per newly notified case was 0.86. The mean duration of hospital stay per admission was 86 days for non-DOTS regions and 90 days for regions where the DOTS strategy had been implemented. The number of admissions in each region correlated closely with the number of newly registered cases and hospital beds were, on average, occupied for 325 days. In the regions where the DOTS strategy had been implemented bed occupancy was 324 days. CONCLUSIONS: Under the Russian tuberculosis control system, hospital utilization is predominantly determined by supply-side factors, namely the number of tuberculosis dedicated hospital beds, and this system extends across all regions. Implementation of the DOTS strategy in Russia has not led to fundamental structural changes in tuberculosis control systems.     

Reaching the targets for tuberculosis control: the impact of HIV

In 1991, the 44th World Health Assembly set two key targets for global tuberculosis (TB) control to be reached by 2000: 70% case detection of acid-fast bacilli smear-positive TB patients under the DOTS strategy recommended by WHO and 85% treatment success of those detected. This paper describes how TB control was scaled up to achieve these targets; it also considers the barriers encountered in reaching the targets, with a particular focus on how HIV infection affects TB control. Strong TB control will be facilitated by scaling-up WHO-recommended TB/HIV collaborative activities and by improving coordination between HIV and TB control programmes; in particular, to ensure control of drug-resistant TB. Required activities include more HIV counselling and testing of TB patients, greater use and acceptance of isoniazid as a preventive treatment in HIV-infected individuals, screening for active TB in HIV-care settings, and provision of universal access to antiretroviral treatment for all HIV-infected individuals eligible for such treatment. Integration of TB and HIV services in all facilities (i.e. in HIV-care settings and in TB clinics), especially at the periphery, is needed to effectively treat those infected with both diseases, to prolong their survival and to maximize limited human resources. Global TB targets can be met, particularly if there is renewed attention to TB/HIV collaborative activities combined with tremendous political commitment and will.