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Evolución del control de la tuberculosis y perspectivas para reducir la incidencia, la prevalencia y las muertes por
Christopher Dye1, Catherine J Watt, Daniel M Bleed
1Stop TB Department, World Health Organization, Geneva, Switzerland. dyec@who.int
JAMA
|June 9, 2005
Resumen
Los programas de control de la tuberculosis (TB) muestran progresos, con un aumento de la detección de casos y las tasas de éxito del tratamiento a nivel mundial. Sin embargo, alcanzar los Objetivos de Desarrollo del Milenio para 2015 requiere intensificar los esfuerzos, especialmente en África y Europa del Este.
Área de la Ciencia:
- Salud Pública La salud pública.
- Epidemiología de las enfermedades infecciosas.
- Política de salud global Política de salud global.
Sus antecedentes:
- Los Objetivos de Desarrollo del Milenio (ODM) de las Naciones Unidas impulsan las evaluaciones de las estrategias de control de la tuberculosis (TB) como DOTS.
- La evaluación del impacto del DOTS y otras medidas de control de la TB es crucial para los objetivos mundiales de salud.
Objetivo del estudio:
- Evaluar la viabilidad de alcanzar los objetivos del ODM para el control de la tuberculosis para 2015.
- Los objetivos clave incluyen la detección del 70% de los nuevos casos de frotis positivos, el tratamiento exitoso del 85% y la reducción de la incidencia, prevalencia y muertes por tuberculosis.
Principales métodos:
- Utilizó notificaciones de casos de TB, resultados del tratamiento de cohorte, registros de muertes y encuestas de prevalencia de hasta 200 países (1980-2003).
- Datos obtenidos de la base de datos mundial de TB de la OMS, incluidos los programas DOTS y no DOTS.
- Incidencia estimada de TB, prevalencia y tasas de mortalidad hasta 2015 para 9 regiones globales distintas.
Principales resultados:
- La incidencia mundial de TB aumentó en 2003, pero las tasas se estabilizaron o disminuyeron en 7 de 9 regiones, excluyendo partes de África afectadas por el VIH.
- La detección de casos de DOTS mejoró significativamente, alcanzando el 45% en 2003 y se prevé que alcance el 60% para 2005.
- Las tasas generales de éxito del tratamiento superaron el 80% desde 1998, aunque persisten las variaciones regionales, con las tasas más bajas en África y Europa del Este.
Conclusiones:
- El logro de los objetivos del ODM para la reducción de la TB para 2015 es posible para la mayoría de las regiones.
- Sigue habiendo desafíos significativos en África y Europa del Este, lo que hace necesario intensificar los esfuerzos de control de la tuberculosis.
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