在艾滋病毒流行环境中通过社区护理预防结核病:一个建模分析
Jennifer M Ross1, Chelsea Greene2, Cara J Bayer3
1Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA.
medRxiv : the preprint server for health sciences
|September 4, 2023
概括
社区为艾滋病毒感染者提供护理,大大降低了结核病 (TB) 发病率和死亡率. 这种方法还通过增加获得抗逆转录病毒疗法 (ART) 和结核病预防治疗 (TPT) 的机会来降低结核病性别差异.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 抗逆转录病毒疗法 (ART) 和结核病预防治疗 (TPT) 对于预防艾滋病毒感染者的结核病 (TB) 死亡至关重要.
- 差异化的护理模式,例如基于社区的护理,可以改善ART和TPT的吸收,特别是在高艾滋病毒相关的结核病负担地区.
研究的目的:
- 模拟扩大基于社区的ART和TPT护理对结核病发病率,死亡率和性别差异的影响,南非克瓦祖鲁纳塔尔省.
- 评估基于社区的艾滋病毒相关结核病护理模式的成本效益.
主要方法:
- 一个按性别分层的动态模型模拟了100,000名成年人 (15-59岁) 的结核病和艾滋病毒传播.
- 模型参数来自DO ART试验和科学文献.
- 模拟预测了未来十年 (2018-2027) 的结果,比较了基于社区的护理与基于诊所的标准护理.
主要成果:
- 基于社区的ART和TPT护理可以在十年内将结核病发病率降低29.7%,结核病死亡率降低36%.
- 该模型减少了结核病死亡率的性别差异,预计男性减少39.8%,女性减少30.9%.
- 避免每年残疾调整寿命 (DALY) 的平均成本为846美元.
结论:
- 扩大社区基础的ART和TPT显著增加覆盖率,减少高艾滋病毒负担环境中的结核病发病率和死亡率.
- 基于社区的护理有效地减少了艾滋病毒感染者结核病死亡率的性别差异.
- 基于社区的护理模式为管理与艾滋病毒相关的结核病提供了具有成本效益的策略.
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