山东省日照市2001—2009年肺结核发病情况及DOTS策略实施效果的研究

目的了解日照市《规划》实施情况,摸清结核病发病规律,评价DOTS策略的执行效果,为制定《结核病防治规划(2011—2020)年》提供科学依据。方法通过对日照市2001—2009年登记管理的病人,以病人登记本、月报、季报和年报为来源,进行患病登记率、流行特征、DOTS策略执行情况进行分析,并对DOTS效果及社会效益进行评价研究。结果 2001—2009年登记患病率为44.06/10万,新涂阳登记率24.17/10万;新发涂阳病人强化期结束痰菌阴转率为98.7%,治愈率为96.7%;避免54 992人感染结核菌,避免5 499人发病,为社会节约医疗费用3 746 348.25元,为社会挽回损失总价值891 549 068.57元。结论日照市积极推行现代结核病控制策略,加强了DOTS管理措施,使结核病人的发现率和治愈率有了显著提高,较好的完成了《全国结核病防治规划(2001—2010)年》总体目标任务,收到了良好的效果和社会效益。     

山东省莒县2003-2013年登记结核病流行特征及DOTS策略实施效果的评价分析

目的 了解《莒县结核病防治规划(2001-2010年)》(简称“《莒县规划》”)实施情况,摸清区域人群的结核病发病规律,科学评价《莒县规划》实施情况和DOTS策略的执行效果,为制定完善莒县结核病控制策略及对策提供科学依据.方法 莒县2003-2013年间全县总人口为12 166 055人,以结核病管理信息系统及相关统计报表数据为来源,对莒县2003-2013年登记管理的4481例结核病患者进行登记率、流行病学特征、治疗效果进行分析,并对DOTS效果及社会效益进行评价分析.结果 2003-2013年登记率为36.83/10万(4481/12 166 055);新涂阳登记率为21.59/10万(2627/12 166 055);男∶女=2.74∶1;登记率年龄组分布前三位分别为15～岁组[21.36％ (957/4481)]、55～岁组[17.96％(805/4481)]和65～74岁组[15.53％ (696/4481)];职业分布以农民为主,占87.61％ (3926/4481);新涂阳患者强化期结束痰菌阴转率为98.82％(2596/2627);复治涂阳患者强化期结束痰菌阴转率为95.91％(211/220),涂阳患者平均治愈率为95.36％(2715/2847).避免22 460人感染结核分枝杆菌,避免新发结核病患者2246例,为社会节约医疗费用1 533 765元,为社会挽回损失总价值266 685 094元.结论 莒县积极推行现代结核病控制策略,2003-2013年结核病登记率呈逐年下降趋势,患者治愈率达到并超过了《莒县规划》要求,DOTS策略实施效果显著.     

温州市结核病控制项目工作效果评价

目的　分析温州市 7年来结核病控制项目工作执行的成效。方法 对温州市 1996—2002年结核病控制项目的执行情况进行总结分析。结果 全市全面实施结核病控制项目工作，加强了结核病综合防治措施，传染源发现和治愈率逐年提高，新发涂阳病人登记率由 1996年的 7.54/10万上升到 2002年的 20.98/10万，治愈率由 1996年的 71.3%上升到 2001年的 92.3%。结论 温州市全面实施浙江省结核病控制项目和CIDA WHO中国结核病控制项目效果显著，DOTS策略得到扩展。     

广东省东莞市实施DOTS策略10年效果分析

目的分析东莞市实施DOTS策略的效果。方法收集并分析1992—2001年项目季报表、年报表及相关资料。结果10年间共投入结防经费316.37万元,接诊27299名可疑症状者,为4330例涂阳和重症涂阴病人提供免费治疗。每例病人平均费用730.65元。涂阳登记率、新发涂阳登记率,初、复治涂阳2、3个月末转阴率及治愈率呈逐年上升态势。初治涂阳平均治愈率为98%,复治涂阳平均治愈率84.4%。结论DOTS策略的成功实施加速了防治工作的开展,使结核病防治技术进入规范化管理。     

佛山市结核病控制项目1O年效果分析(1992-2001年)

目的　分析广东省佛山市结核病控制项目10年的效果以及取得成效的原因。方法 收集、分析1992-2001年佛山市实施世界银行贷款结核病控制项目资料。结果 1992-2001年共接诊可疑肺结核症状者40470例,发现活动性肺结核病人8652例。其中涂阳肺结核病人5005例,新发涂阳4320例,复治涂阳病人685例;新发涂阳登记率由1993年的7.47/10万上升至2001年的30.30/10万;初治涂阳治愈率由1993年的73.5%上升至2001年的99.4%;复治涂阳治愈率由1993年的60.8%上升至2001年的91.4%。结论 10年来,佛山市的结核病控制项目实行免费检查治疗、归口管理和执行DOTS策略,实现了“高发现率”和“高治愈率”的目标,结核病控制水平整体提高,为实施新项目提供宝贵的经验,促进佛山市结核病控制工作的可持续发展。     

2001～2009年新疆伊宁市肺结核病人发现及治疗转归分析

目的评价2001～2009年新疆伊宁市肺结核病人发现及治疗效果。方法利用伊宁市2001～2009年结核病控制项目季度报表及结核病防治规划（2001～2010年）终期评估报告资料进行分析。结果 2001～2009年共登记活动性肺结核病例3697例,其中新涂阳1548例,复治涂阳458例。各年新发涂阳登记率分别为10万人口中37.6、42.8、28.0、34.2、44.2、56.3、51.4、46.0、46.2和新发涂阳治愈百分率分别为87.2、87.4、81.8、84.4、89.7、93.8、85.2、78.4、88.2。结论全面实施DOTS策略后,病人的发现率有了一定提高,治愈率达到了国家要求目标。     

2005年全国新涂阳肺结核病人发现资料分析

目的了解2005年全国结核病病人发现工作进展情况。方法利用2005年全国结核病控制工作季报表资料对新涂阳肺结核病人登记资料进行分析。结果2005年全国各级结核病防治机构共登记新涂阳肺结核病人471732例,新涂阳肺结核病人的登记率为36.06/10万,发现率为78.67%。男性登记数和登记率均高于女性,登记率呈随年龄增长而增高的趋势。31个省(自治区、直辖市)登记率波动在4.22/10万～72.43/10万之间。新涂阳肺结核病人登记率与初诊病人占全人口比例成正相关(r=0.705)。结论2005年全国新涂阳肺结核病人发现率达到了既定目标,但全国的结核病防治工作仍需要进一步加强。     

汕头市涂阳肺结核控制效果分析

目的评价广东省汕头市涂阳肺结核病控制效果。方法对1992~2001年登记的初治涂阳肺结核病人的发现、登记、治疗管理及转归等进行评价。结果共接诊可疑肺结核病症状者76925例,发现活动性肺结核病人18653例,涂阳肺结核新登记率由1992年2.71/10万上升到2001年35.97/10万,初治涂阳病人治愈率由64.7%上升到97.7%,复治涂阳病人治愈率由38.2%上升到85.1%。初复治比例由1992年的12.0下降到2001年的1±0.1。结论推行DOTS策略,政府重视、经费到位,建立健全三级防痨网,是肺结核病疫情明显改善的基础。     

温州市结核病控制项目工作效果评价

目的 分析温州市7年来结核病控制项目工作执行的成效。方法 对温州市1996—2002年结核病控制项目的执行情况进行总结分析。结果 全市全面实施结核病控制项目工作，加强了结核病综合防治措施，传染源发现和治愈率逐年提高，新发涂阳病人登记率由1996年的7．54／10万上升到2002年的20.98／10万，治愈率由1996年的71．3％上升到2001年的92．3％。结论 温州市全面实施浙江省结核病控制项目和CIDA-WHO中国结核病控制项目效果显著，DOTS策略得到扩展。     

陕西省世界银行贷款/英国赠款结核病控制项目6年效果分析

目的分析陕西省世界银行贷款/英国赠款结核病控制项目实施6年的效果,为我省结核病防治工作可持续发展提供可参考。方法收集2002—2007年陕西省107个区(县)项目季报表,对全省DOTS策略覆盖率、肺结核可疑症状者就诊率、肺结核患者登记率和治愈率等主要指标进行统计分析。结果全省2002年启动DOTS策略,2005年以县为单位DOTS策略覆盖率达到了100%。2002—2007年,全省接诊肺结核可疑症状者386281例,可疑症状者就诊率逐年增高;发现涂阳肺结核患者61293例,其中新涂阳肺结核患者45123例,新涂阳肺结核登记率平均为20.45/10万,2004—2007年,新涂阳肺结核发现率平均为87.72%。初治涂阳肺结核治愈率平均为90.6%,复治涂阳患者治愈率平均为81.7%。结论该项目促进了DOTS策略的快速扩展,提高了肺结核患者的发现率和治愈率,产生了明显的社会效益和经济效益。     

江西省吉安市2001—2008年结核病防治工作进展分析

目的 探讨肺结核患者应用利福平所致急性肾功能衰竭(ARF)的原因、特点并提高重视。方法 对天津市海河医院近5年来收治的利福平所致的急性肾功能衰竭8例，在年龄、用药特点、治疗及预后等进行分析。结果病例以老年人为主（6/8例），其中6例既往有应用利福平史，8例患者均在住院后规则应用包括利福平在内的抗结核方案治疗，用药1个月以内出现急性肾功能衰竭。结论 在应用利福平抗结核治疗时应提高警惕，密切观察，注意急性肾衰的发生，特别是老年患者和既往曾经应用过利福平的病人。     

高州市实施结核病控制项目十年效果评价

目的　高州市实施结核病控制项目的评价。方法　因症就诊胸透筛选痰检确诊病人 ,按统一化疗方案治疗 ,实行全程督导管理。结果　 10年间共接诊可疑肺结核症状者 2 0 12 4人 ,可疑者检痰率为 37.77% ,发现活动性肺结核 5 10 8例 ,其中涂阳肺结核、新发涂阳肺结核分别为 3971和 3317例。涂阳登记率由 13/ 10万提高到 33/10万 ;初治涂阳治愈率达 97.71%、复治涂阳治愈率达 84 .10 %。结论　 10年来结核病控制水平全面提高 ,是实施DOTS现代结核病控制策略的结果。     

545例住院结核病人耐多药现状分析

目的了解近年来滨州市住院结核病人的耐多药现状,为结核病的防控提供参考。方法以545例在滨州市结核病防治院住院的结核病人作为研究对象,分析其实验室及临床资料。结果 545例住院结核病人,初始耐药率16.3%,耐多药率3.6%,获得性耐药率24.8%,耐多药率17.2%,复治组耐多药率显著高于初治组,两组对比,均相差显著(P<0.01),有统计学意义,不规则用药是造成耐多药的主要因素。结论滨州市耐多药情况严重,需要严格执行结核病控制策略,加强方法学的研究,确保DOTS策略的实施,保证耐多药结核病人得到规范、有效的治疗管理,防止耐药菌株的产生和传播。     

现代结核病控制策略的实施进展及系统评价

目的 描述及评价DOTS策略的实施情况。方法 由邀请的专家和文献检索人员讨论后确定检索的文献内容和检索词,共检索12个数据库、4个卫生机构网站和搜索引擎Google Scholar,纳入1999-2010年所有描述或评价已经实施的DOTS策略、成本-效益分析、防控经验等的文章记录共2182条,并对文章信息进行提取。结果 共纳入26篇文章及WHO年报,其中WHO年报11篇,评价DOTS策略实施的文章10篇,对DOTS策略实施进行成本-效益分析文章5篇。通过实施DOTS策略患者治愈率提高了13.1%～92.1%不等、治疗成功率提高到了92.4%～95.0%不等、登记率增加了163.0%～217.8%不等;降低了患病率30.0%～50.0%及丢失率73.0%～52.6%不等,同时实施DOTS策略提高了成本-效益。结论 强有力的政府承诺是保持DOTS策略可持续实施的前提,DOTS策略的实施有效地控制了结核病的疫情,同时具有良好的成本-效益。     

Tuberculosis in Asia

1. Philippines: The development, expansion and maintenance of pilot area activities: Cristina B. Giango (Technical Division, Cebu Provincial Health Office, the Philippines) In 1994, the Department of Health developed the new NTP policies based on WHO recommendations and started a pilot project in Cebu Province in collaboration with the Japan International Cooperation Agency. To test its feasibility and effectiveness, the new NTP policies were pre-tested in one city and one Rural Health Unit. The test showed a high rate of three sputum collection (90%), high positive rate (10%), and high cure rate (80%). Before the new guidelines were introduced, the new policy was briefed, a baseline survey of the facility was conducted, equipment was provided, and intensive training was given. Recording/Reporting forms and procedures were also developed to ensure accurate reporting. Supervision, an important activity to ensure effective performance, was institutionalized. Laboratory services were strengthened, and a quality-control system was introduced in 1995 to ensure the quality of the laboratory services. With the implementation of DOTS strategy, barangay health workers were trained as treatment partners. In partnership with the private sector, the TB Diagnostic Committee was organized to deliberate and assess sputum negative but X-ray positive cases. The implementation of the new NTP guidelines in Cebe Province has reached a satisfactory level, the cure rate and positive rate have increased, and laboratory services have improved. Because of its successful implementation, the new NTP guidelines are now being used nationwide. 2. Nepal: The DOTS Strategy in the area with hard geographic situation: Dirgh Singh Bam (National Tuberculosis Center, Nepal) Three groups of factors characterize the population of Nepal: 1) Socio-cultural factors, e.g. migration, poverty, language; 2) Environmental factors, e.g. geography and climate; and 3) Political factors, prisoners and refugee populations. These factors pose particular problems for implementing DOTS in various ways. Socio-cultural and environmental factors are particularly important in Nepal, and several measures have been developed to overcome these difficulties. One is active community participation through the DOTS committee. The committee consists of a group of motivated people, including social workers, political leaders, health services providers, journalists, teachers, students, representatives of local organizations, medical schools and colleges, industries, private practitioners, and TB patients. One DOTS committee is formed in every treatment center. A key role of the DOTS committee is to identify local problems and their solutions. It increases public awareness about TB and DOTS; supports people with TB in the community by providing treatment observers and tracing late patients; and encourages cooperation among health institutions, health workers, NGOs, and political leaders. The case finding rate is now 69%, and nearly 95% of diagnosed TB cases are being treated under DOTS. The treatment success rate of new smear-positive cases is nearly 90%. Thus, DOTS increases the case finding and treatment success. 3. Cambodia: HIV/TB and the health sector reform: Tan Eang Mao (National Center for Tuberculosis and Leprosy Control, Cambodia) Cambodia is one of the 23 high burden countries of tuberculosis in the world. Moreover, HIV/AIDS has been spreading rapidly since 1990s, which is worsening the tuberculosis epidemics. To cope with the burden, Cambodia has started implementation of DOTS in 1994 and has expanded it to most of public hospitals across the country by 1998. NTP of Cambodia is now enjoying high cure rate of more than 90%. However, due to the constraints such as weak infrastructure and the poverty, it is proved that many of TB sufferers do not have access to the TB services, resulting in still low case detection rate. It is for this reason that the NTP has decided to expand DOTS to health center and community level based on the new health system. Its pilot program that has been carried out in collaboration with JICA and WHO since 1999 has achieved promising results with high detection and cure rates. All of the over 900 health centers across the country will be involved in DOTS strategy by 2005. In the fight against TB/HIV, National Center for TB Control is providing free TB screening for PLWH (people living with HIV/AIDS), and it is developing a comprehensive plan of TB/HIV care including home delivery DOT services. 4. China: The World Bank Project and the Prevalence Survey in China: Hong Jin DuanMu (National Tuberculosis Control Center, China) Since 1992, China has utilized a World Bank loan to implement TB control projects among 560 million people in 13 provinces. Free diagnosis and treatment services have been provided to all patients, and a fully supervised standard short-course chemotherapy was applied to all diagnosed tuberculosis patients. In 1999, more than 190,000 smear-positive cases, ten times the number in 1992, were detected, and the registration rate of new cases reached 30 per 100,000 population. From 1992 to 1999, a total of 1.40 million smear-positive TB patients were discovered. The cure rate of smear-positive TB patients has been improved to an overall cure rate of 93.6%. The cure rates for the new cases and re-treatment patients were 95.1% and 89.6%, respectively. The fourth nationwide random survey for the epidemiology of tuberculosis was conducted in 2000. The prevalence of active tuberculosis was 367/100,000, the prevalence of infectious tuberculosis was 160/100,000, and the prevalence of smear-positive tuberculosis was 122/100,000. The tuberculosis mortality was 9.8/100,000. 5. Vietnam: The road to reaching the Global Target: Le Ba Tung (Pham Ngoc Thach Tuberculosis and Lung Disease Center, Vietnam) TB control activities started in 1957 and were reorganized in 1986 with the technical assistance of IUATLD, KNCV and material assistance of Medical Committee Netherlands Vietnam (MCNV). The New National TB Control Program follows the main directives of WHO and IUATLD's procedures of case-finding, chemotherapy and management. Passive case-findings are based on sputum smear. Chemotherapy with priority for smear positive cases is 3SHZ/6S2H2 for new cases and 3HRE/6H2R2E2 for retreated cases, which is undertaken with directly observed therapy (DOT strategy) mainly at commune health posts. Since 1989, DOTS strategy with 2SHRZ/6HE for new cases and 2SHRZE/1HRZE/5H3R3E3 for retreated cases has gradually been introduced in districts and communes of every province. In 1995, the government established the National and Provincial TB Control Steering Committees and has provided incentives for detected smear positive cases and cured smear positive cases. The government has also started strengthening the program of managerial and supervisory capacity for TB staff and has promoted the cooperation of all associated organizations of TB control. The WHO global surveillance and monitoring project reports that in 2000 Vietnam reached the global target, i.e., 99.8% population covered by DOTS with 80% of expected new smear positive cases being detected and a high cure rate ranging from 85.3% in 1989 to 90.3% in 1999. A distinguishing aspect of TB control in Vietnam is the effective international partnerships combined with high political commitment of the government nationally and provincially as well as active participation of all organizations in the community.     

1997—2003年湖北省武昌监狱肺结核病控制效果分析

目的　将监狱结核病控制工作纳入结防规划,降低本地区结核病疫情。方法 1997—2003年在监狱囚犯中发现523例肺结核病人,采用现代结核病控制策略(DOTS)实施治疗及管理,分析其转归。结果 7年来初治涂阳治愈率平均为93.3%,复治涂阳治愈率平均为85.7%;监狱内囚犯涂阳肺结核患病率从1997年的1146.95/10万降至2003年的497.37/10万。结论 7年来在湖北省武昌监狱囚犯中主动发现肺结核病人并实施DOT管理,成效显著。     

Rapid decline in prevalence of pulmonary tuberculosis after DOTS implementation in a rural area of South India

SETTING: Tiruvallur District in Tamilnadu, South India, where the World Health Organization-recommended DOTS strategy was implemented as a tuberculosis (TB) control measure in 1999. OBJECTIVE: To assess the epidemiological impact of the DOTS strategy on the prevalence of pulmonary tuberculosis (PTB). DESIGN: Surveys of PTB were undertaken on representative population samples aged > or =15 years (n = 83000-90000), before and at 2.5 and 5 years after the implementation of the DOTS strategy. The prevalence of PTB (smear-positive/culture-positive) was estimated. RESULTS: TB prevalence declined by about 50% in 5 years, from 609 to 311 per 100000 population for culture-positive TB and from 326 to 169/100000 for smear-positive TB. The annual rate of decline was 12.6% (95%CI 11.2-14.0) for culture-positive TB and 12.3% (95%CI 8.6-15.8) for smear-positive TB. The decline was similar at all ages and for both sexes. CONCLUSION: With an efficient case detection programme and the DOTS strategy, it is feasible to bring about a substantial reduction in the burden of TB in the community.     

Undiagnosed tuberculosis in a community with high HIV prevalence: implications for tuberculosis control

BACKGROUND: Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short-course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program. METHODS: Active case finding for PTB was performed in 762 adults using sputum microscopy and Mycobacterium tuberculosis culture, testing for HIV, and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register. RESULTS: Of those surveyed, 174 (23%) tested HIV positive, 11 (7 HIV positive) were receiving TB therapy, 6 (5 HIV positive) had previously undiagnosed smear-positive PTB, and 6 (4 HIV positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and -negative individuals, prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000, and case-finding proportions were 37 and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However, 87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals. CONCLUSIONS: PTB was identified in 9% of HIV-infected individuals, with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case-finding rates. DOTS strategy based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals.