Rodger Alison J, Toole Mike, Lalnuntluangi Baby, Muana V, Deutschmann Peter
Burnet Institute for Medical Research and Public Health, Melbourne, Australia.
Bull World Health Organ. 2002;80(6):451-6.
To pilot the WHO guidelines on DOTS for tuberculosis (TB) among displaced people affected by conflict in Churachandpur District, Manipur State, north-east India, which has endured an HIV epidemic, injecting drug use, civil unrest, high levels of TB, and poor TB treatment and prevention services for many years.
Prerequisites for TB control programmes were established. WHO guidelines and protocols were adapted for local use. Outreach workers were appointed from each ethnic group involved in the conflict, and training was conducted. Quality control and evaluation processes were introduced.
TB was diagnosed in 178 people between June and December 1998. Of the 170 with pulmonary disease, 85 were smear-positive. Successful outcomes were recorded in 91% of all patients and in 86% of smear-positive cases of pulmonary TB. The default rate and the mortality rate were low at 3% each. HIV positive serostatus was the only factor associated with a poor treatment outcome.
TB treatment and control were possible in a conflict setting and WHO targets for cure were attainable. The factors associated with the success of the programme were strong local community support, the selection of outreach workers from each ethnic group to allow access to all areas and patients, the use of directly observed therapy three times a week instead of daily in the interest of increased safety, and the limiting of distances travelled by both outreach workers and patients.
在印度东北部曼尼普尔邦丘拉昌德布尔地区受冲突影响的流离失所人群中试行世界卫生组织的结核病直接督导下的短程化疗（DOTS）指南。该地区多年来一直面临艾滋病毒流行、注射吸毒、内乱、结核病高发以及结核病治疗和预防服务不佳的问题。
确立了结核病控制项目的先决条件。对世界卫生组织的指南和方案进行了调整以适用于当地。从参与冲突的每个族群中任命了外展工作人员，并开展了培训。引入了质量控制和评估流程。
1998年6月至12月期间，178人被诊断出患有结核病。在170例患有肺部疾病的患者中，85例痰涂片呈阳性。所有患者的成功治疗率为91%，肺结核痰涂片阳性病例的成功治疗率为86%。失访率和死亡率均较低，各为3%。艾滋病毒血清学阳性是与治疗效果不佳相关的唯一因素。
在冲突环境中结核病的治疗和控制是可行的，世界卫生组织的治愈目标是可以实现的。该项目成功的相关因素包括当地社区的大力支持、从每个族群中挑选外展工作人员以便能够接触到所有地区和患者、为了提高安全性每周进行三次而非每日进行直接观察治疗，以及限制外展工作人员和患者的行程距离。
