Harries Anthony D, Hargreaves Nicola J, Chimzizi Rehab, Salaniponi Felix M
National Tuberculosis Control Programme, Ministry of Health, Lilongwe, Malawi.
Bull World Health Organ. 2002;80(6):464-9.
HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and TB (tuberculosis) are two of the world's major pandemics, the brunt of which falls on sub-Saharan Africa. Efforts aimed at controlling HIV/AIDS have largely focused on prevention, little attention having been paid to care. Work on TB control has concentrated on case detection and treatment. HIV infection has complicated the control of tuberculosis. There is unlikely to be a decline in the number of cases of TB unless additional strategies are developed to control both this disease and HIV simultaneously. Such strategies would include active case-finding in situations where TB transmission is high, the provision of a package of care for HIV-related illness, and the application of highly active antiretroviral therapy. The latter is likely to have the greatest impact, but for this therapy to become more accessible in Africa the drugs would have to be made available through international support and a programme structure would have to be developed for its administration. It could be delivered by means of a structure based on the five-point strategy called DOTS, which has been adopted for TB control. However, it may be unrealistic to give TB control programmes the responsibility for running such a programme. A better approach might be to deliver highly active antiretroviral therapy within a comprehensive HIV/AIDS management strategy complementing the preventive work already being undertaken by AIDS control programmes. TB programmes could contribute towards the development and implementation of this strategy.
艾滋病毒/艾滋病（人类免疫缺陷病毒/获得性免疫缺陷综合征）和结核病是世界上两大主要流行病，撒哈拉以南非洲首当其冲。旨在控制艾滋病毒/艾滋病的努力主要集中在预防方面，而对护理关注甚少。结核病控制工作则集中在病例发现和治疗上。艾滋病毒感染使结核病的控制变得复杂。除非制定额外的策略来同时控制这两种疾病，否则结核病病例数不太可能下降。这些策略将包括在结核病传播率高的情况下积极发现病例、为与艾滋病毒相关的疾病提供一揽子护理，以及应用高效抗逆转录病毒疗法。后者可能产生最大影响，但要使这种疗法在非洲更易获得，就必须通过国际支持提供药物，并建立一个管理该疗法的方案结构。可以通过基于名为直接观察短程疗法（DOTS）的五点策略的结构来提供这种疗法，该策略已被用于结核病控制。然而，让结核病控制方案负责实施这样一个方案可能不现实。更好的方法可能是在全面的艾滋病毒/艾滋病管理策略中提供高效抗逆转录病毒疗法，以补充艾滋病控制方案已经开展的预防工作。结核病方案可以为该策略的制定和实施做出贡献。
