Nunn Paul, Harries Anthony, Godfrey-Faussett Peter, Gupta Raj, Maher Dermot, Raviglione Mario
Tuberculosis Strategy and Operations, STOP TB Department, World Health Organization, Switzerland.
Bull World Health Organ. 2002;80(6):471-6.
The development of WHO's DOTS strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation and improvement of operational research in this area. From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multicountry projects that were also concerned with health policy and the needs of health systems. The results are now being put into practice by national TB control programmes. In 1998 an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multidrug resistance. An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article. We discuss the prerequisites for success, the shortcomings of this WHO- supported programme, and future challenges and needs.
1995年世界卫生组织控制结核病的直接督导下短程化疗（DOTS）策略的制定，促使该领域的运筹学得到扩展、调整和改进。结核病运筹学从关注服务提供方面的小规模研究拼凑，转变为关注卫生政策和卫生系统需求的大规模、通常是多国项目。这些成果目前正由各国结核病控制规划付诸实践。1998年，一个特设委员会确定了阻碍DOTS扩展的主要因素：缺乏政治意愿和承诺、对结核病控制的财政支持不足、卫生服务的组织和管理不善、人力资源不足、药品供应不规律、艾滋病毒流行以及多重耐药性的上升。本文基于这些制约因素对当前结核病运筹学研究进行了分析，并概述了成功项目的实例。我们讨论了成功的先决条件、世卫组织支持的该项目的缺点以及未来的挑战和需求。
