Nolan C M
Seattle-King County Department of Public Health and The University of Washington, USA.
Clin Infect Dis. 1999 Oct;29(4):880-7. doi: 10.1086/520453.
Treatment of latent infection due to Mycobacterium tuberculosis will likely increase in importance as a strategy to prevent tuberculosis in the United States. This review was undertaken to assess how targeted testing and treatment of latent tuberculosis infection are currently organized, with a focus on the extension of those services from public health clinics to other community sites. Targeted testing programs are now being implemented in primary care neighborhood clinics, syringe-exchange programs, jails, and teen health clinics. Organizational issues at those new sites include the need for a tracking system for clinical follow-up and for incentives to promote adherence. There is increasing experience with directly observed treatment of latent tuberculosis infection. Communities that receive large numbers of immigrants and refugees should prioritize the evaluation of those whose chest radiographs are suggestive of tuberculosis. Current studies continue to point out imperfections in the current tools, such as the tuberculin skin test and isoniazid. Finally, the advent of managed care, especially for Medicaid recipients, presents both opportunities and challenges for expansion of population-based preventive health services.
作为美国预防结核病的一项策略，治疗结核分枝杆菌潜伏感染的重要性可能会日益增加。本综述旨在评估目前针对潜伏性结核感染的检测和治疗是如何组织开展的，重点关注这些服务从公共卫生诊所扩展到其他社区场所的情况。目前，在基层医疗社区诊所、针头交换项目、监狱和青少年健康诊所中正在实施针对性检测项目。这些新场所的组织问题包括需要一个临床随访跟踪系统以及促进依从性的激励措施。直接观察下的潜伏性结核感染治疗经验日益丰富。接收大量移民和难民的社区应优先评估胸部X光片提示有结核病的人群。当前的研究继续指出现有工具（如结核菌素皮肤试验和异烟肼）存在的不足之处。最后，管理式医疗的出现，尤其是针对医疗补助受益人的管理式医疗，为扩大基于人群的预防性健康服务带来了机遇和挑战。
