11年来,我一直在社区进行结核病的直接观察治疗
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
概括
基于社区的直接观察治疗 (DOT) 显著减少了巴尔的摩的结核病 (TB) 发病率. DOT计划改善了治疗完成率和唾液转化率,证明了结核病控制的有效性.
科学领域:
- 公共卫生 公共卫生
- 传染病控制和控制传染病
- 流行病学 流行病学
背景情况:
- 在20世纪80年代,结核病 (TB) 发病率在全国范围内有所增加.
- 巴尔的摩面临着对结核病传播的重大医疗社会风险因素.
- 基于社区的直接观察治疗 (DOT) 在城市环境中控制结核病的有效性尚未得到充分证实.
研究的目的:
- 评估基于社区的直接观察治疗 (DOT) 对结核病 (TB) 控制的影响.
- 为了比较巴尔的摩与美国其他主要城市的结核病发病率,治疗完成率和唾液转化率.
- 评估DOT在高患风险因素的地区减轻结核病的作用.
主要方法:
- 采用了生态研究设计,将巴尔的摩的结核病数据与美国其他20个大都会城市的结核病数据进行比较.
- 在11年的回顾性分析中,研究了结核病例率,唾液转化率 (SCRs) 和治疗完成率.
- 在比较中考虑了艾滋病,移民,失业和贫困等混因素.
主要成果:
- 巴尔的摩在1981年至1992年期间,结核病发病率下降了51.7%,与其他城市群体的增加形成鲜明对比.
- 巴尔的摩的DOT管理的病例显示出高的唾液转化率 (90.7%) 和治疗完成率 (90.1%).
- 尽管存在普遍的医疗社会风险因素,但仍观察到这些积极趋势,并且不能归因于艾滋病,移民,贫困或失业率的差异.
结论:
- 在巴尔的摩,基于社区的DOT实施与结核病发病率的大幅下降有关.
- DOT促进了高治疗完成率和细菌治疗,有助于有效控制结核病.
- 直接观察治疗是一种可行的策略,可以减少美国城市的结核病发病率,特别是那些病例率高的城市.
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