11年間,結核に対するコミュニティベースの直接観察療法を行ってきました
C P Chaulk1, K Moore-Rice, R Rizzo
1Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA.
JAMA
|September 27, 1995
まとめ
コミュニティベースの直接観察療法 (DOT) は,ボルチモアで結核 (TB) の発生率を大幅に減少させた. DOTのプログラムは,治療の完了率と唾液の変換率を向上させ,結核管理に有効であることが証明されました.
科学分野:
- 公衆衛生は公衆衛生である.
- 感染症のコントロール・コントロール
- エピデミオロジー エピデミオロジー
背景:
- 結核 (TB) の発生率は,1980年代に全国的に増加しました.
- ボルチモアは,結核の伝播のための重要な医学的社会的リスク要因に直面しました.
- 都市部での結核の制御のためのコミュニティベースの直接観察療法 (DOT) の有効性は十分に確立されていません.
研究 の 目的:
- 結核 (TB) 制御に対するコミュニティベースの直接観察療法 (DOT) の影響を評価する.
- ボルチモアの結核発生率,治療完了率,および唾液変換率を他の主要米国都市と比較するために.
- リスク因子の高流行地域における結核の緩和におけるDOTの役割を評価する.
主な方法:
- ボルチモアのTBデータを他の20の都市と比較したエコロジカル・スタディ・デザインが採用されました.
- 11年間の遡及分析では,結核症例率,唾液変換率 (SCRs),治療完了率を調査した.
- エイズ,移民,失業,貧困などの混同要因が比較に考慮された.
主要な成果:
- ボルチモアでは,1981年から1992年の間に結核の発生率が51.7%低下し,他の都市群の増加と対照的であった.
- ボルチモアでDOTが管理した症例は,高い唾液変換 (90.7%) と治療完了 (90.1%) の割合を示しました.
- これらのポジティブな傾向は,医学社会的なリスク要因が蔓延しているにもかかわらず観察され,エイズ,移民,貧困,または失業の違いに起因するものではありませんでした.
結論:
- ボルチモアのコミュニティベースのDOTの実施は,結核の発生率の大幅な減少と関連していました.
- DOTは高い治療完了率と細菌学的治癒を促進し,効果的な結核管理に貢献しました.
- 直接観察療法は,米国の都市,特に高症例率の都市で結核の発生率を減らすための実行可能な戦略です.
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