介绍结核病治疗的差异化服务提供模式:一个试点项目,为乌干达的国家政策提供信息
Odile Ferroussier-Davis1, Deus Lukoye2, Susan Alwedo3
1U.S. Centers for Disease Control and Prevention, Global Health Center, Division of Global HIV & TB, Atlanta, Georgia, USA.
Journal of the International AIDS Society
|July 7, 2025
概括
在乌干达,差异化服务交付 (DSD) 模式改善了结核病 (TB) 治疗成功率. 与历史数据相比,这些调整后的模型显示出了有利的结果,突出显示了它们在结核病治疗中的有效性.
科学领域:
- 公共卫生 公共卫生
- 传染病管理 传染病管理
- 加强卫生系统 加强卫生系统
背景情况:
- 差异化服务交付 (DSD) 模式旨在根据患者的需求和偏好来个性化医疗保健,旨在提高效率并降低卫生系统的负担.
- 在乌干达,最初为艾滋病毒服务开发的DSD模型被调整为结核病 (TB) 护理,以解决COVID-19大流行引起的服务中断,并改进国家结核病管理战略.
研究的目的:
- 评估适应的DSD模型对乌干达结核病治疗结果的实施和影响.
- 通过基于设施和基于社区的DSD方法来评估定制结核病服务的可行性.
主要方法:
- 从2021年4月开始,四个基于设施和五个基于社区的DSD模型在乌干达坎帕拉和索罗蒂地区的28家结核病诊所中实施.
- 客户偏好和临床医生协议指导了DSD模型的选择,允许可变的药物发行间隔,包括多个月的发行 (MMD).
- 对1864名注册客户的结核病注册表和DSD跟踪工具 (2022年12月) 的数据进行了分析,将结核病治疗成功率与2018-2019年历史数据进行了比较.
主要成果:
- 超过97%的注册TB客户使用至少一个DSD模型,其中基于设施的个人管理和家庭交付是最常见的.
- 包括MMD在内的客户接受更长的分发间隔的比例显著增加,从密集到治疗的延续阶段.
- 在DSD队列中,结核病治疗的整体成功率为84.9%,与72.9%的历史成功率相比,有显著的改善 (p < 0.001).
结论:
- 在乌干达结核病服务中实施DSD模型取得了成功,证明了治疗结果的改善.
- 在DSD模型下,结核病治疗成功率明显高于历史基准,这表明这种方法的有效性.
- 建议对影响MMD吸收和模型选择的因素进行进一步研究,以优化未来的DSD程序设计,以治疗结核病.
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