Libamba E, Makombe S, Harries A D, Chimzizi R, Salaniponi F M, Schouten E J, Mpazanje R
Department of Clinical Services, Ministry of Health, Lilongwe, Malawi.
Int J Tuberc Lung Dis. 2005 Oct;9(10):1062-71.
The rapid and massive scale-up of antiretroviral drug therapy (ART) so needed in sub-Saharan Africa will not be possible using a 'medicalised' model. A more simple approach is required. DOTS has been used now for many years to provide successful anti-tuberculosis treatment to millions of patients in poor countries of the world, and many of the established concepts can be used for the delivery of ART. Malawi, a small and impoverished country in sub-Saharan Africa, is embarking on a national scale-up of ART. In this review we describe how we have adopted several of the principles of DOTS for delivering ART in Malawi: case finding and registration, treatment, monitoring, drug procurement, staffing and the issue of free drugs. We also discuss ART for HIV-infected TB patients. We hope that by using the DOTS approach we will be able to deliver ART to large numbers of HIV-infected patients under controlled conditions, and minimise the risk of developing drug resistance.
在撒哈拉以南非洲地区，采用“医疗化”模式无法实现抗逆转录病毒药物治疗（ART）所需的快速大规模推广。需要一种更简单的方法。多年来，直接观察短程疗法（DOTS）已被用于为世界上贫穷国家的数百万患者提供成功的抗结核治疗，许多既定概念可用于提供抗逆转录病毒治疗。马拉维是撒哈拉以南非洲的一个小国且贫困，正在全国范围内推广抗逆转录病毒治疗。在本综述中，我们描述了我们如何在马拉维采用DOTS的若干原则来提供抗逆转录病毒治疗：病例发现与登记、治疗、监测、药品采购、人员配备以及免费药品问题。我们还讨论了针对感染艾滋病毒的结核病患者的抗逆转录病毒治疗。我们希望通过采用DOTS方法，能够在可控条件下为大量感染艾滋病毒的患者提供抗逆转录病毒治疗，并将产生耐药性的风险降至最低。
