预防结核病以社区为基础的护理在艾滋病毒流行环境:一个建模分析
Jennifer M Ross1, Chelsea Greene2, Cara J Broshkevitch3
1Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
Journal of the International AIDS Society
|June 11, 2024
概括
基于社区的护理显著提高了艾滋病毒感染者获得抗逆转录病毒疗法 (ART) 和结核预防治疗 (TPT) 的机会. 这种方法有效地减少了结核病 (TB) 的发病率和死亡率,特别是在高负担地区.
科学领域:
- 流行病学 流行病学
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
背景情况:
- 抗逆转录病毒治疗 (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,以社区为基础的护理模式可以改善ART和TPT的吸收,特别是在艾滋病毒相关结核病负担高的地区,包括男性.
研究的目的:
- 模拟扩大社区ART和TPT护理对结核病发病率,死亡率和成本效益的影响.
- 评估基于社区的模型的潜力,以减少艾滋病毒感染者的结核病结果中的性别差异.
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) 在南非克瓦祖鲁-纳塔尔省的结核病和艾滋病毒传播.
- 参数来自DO ART试验和科学文献,模拟了10年的扩大社区护理.
- 预计的结果包括结核病例,死亡,预防的残疾调整寿命年 (DALYs),计划成本和增量成本效益比率 (ICERs).
主要成果:
- 基于社区的ART护理可以在10年内将结核病发病率降低27.0%,死亡率降低34.6%.
- 将TPT整合到社区护理中可以进一步减少结核病发病率的29.7%,死亡率的36.0%.
- 基于社区的ART与TPT护理减少了结核病死亡率的性别差异,与标准护理相比,预计每年男性死亡人数从109人减少到54人. 平均每DALY避免的成本为846美元.
结论:
- 扩大社区基础的ART和TPT显著增加了艾滋病毒感染者的覆盖范围.
- 这种方法在高艾滋病毒相关结核病环境中有效降低结核病发病率和死亡率.
- 基于社区的护理模式在减轻结核病发病结果的性别差异方面表现有前途.
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