Bumburidi Ekaterina, Ajeilat S, Dadu A, Aitmagambetova I, Ershova J, Fagan R, Favorov M O
Applied Epidemiology Training Program, CDC/Central Asia Office, Division of International Health, Office of Global Health, CDC, Atlanta, GA 30333, USA.
MMWR Suppl. 2006 Apr 28;55(1):11-5.
In Kazakhstan, during 1995-2002, the annual notification rate per 100,000 population for new cases of tuberculosis (TB) increased from 67.1 to 165.1. Beginning in 1998, public health authorities have used the national case management strategy (DOTS) promulgated by the World Health Organization (WHO) to control TB. Intended goals of DOTS include achieving a cure rate of >85% for persons with newly detected pulmonary TB sputum-smear-positive (PTB+) cases and having PTB+ represent >65% of all PTB cases among adults. Surveillance data collected during 2000-2002 were analyzed to evaluate progress toward achieving these goals and identify factors associated with specific treatment outcomes.
Surveillance data included the following nonidentifiable information on persons with newly reported cases of PTB: dates of disease onset and treatment initiation; methods of diagnosis; treatment outcomes; HIV status; and selected demographic, socioeconomic, and behavioral characteristics. Cure rates and proportions of PTB+ cases were calculated on the basis of the TB case definition and treatment outcome classification format outlined in DOTS guidelines issued by WHO. Denominator data to calculate rates were obtained from the National Census Office of Kazakhstan. Logistic regression was employed to investigate factors associated with treatment outcomes using Epi Info version 3.2.
During 2000-2002, a total of 65,011 new cases of PTB were detected in Kazakhstan. The average annual countrywide notification rate per 100,000 population was 146.0; provincial notification rates varied (range: 65.1-274.0). The countrywide cure rate for newly detected PTB+ was 72.2%; provincial rates varied (range: 65%-81%). Of 59,905 cases of PTB among adults during 2000-2002, a total of 26,804 (44.7%) were PTB+. Unfavorable treatment outcome of new PTB+ cases was associated with alcohol abuse, homelessness, and previous incarceration.
The cure rate for new PTB+ cases and the proportion of cases of PTB+ among all adults with PTB were below targeted goals. This might, in part, be explained by the 1998 adoption of DOTS. Improving program indicators requires evaluation of detection efforts, laboratory diagnostic capabilities, and adherence to treatment regimens, especially in provinces in which rates are high and among persons at high risk for unfavorable treatment outcomes.
在哈萨克斯坦，1995 - 2002年期间，每10万人口中结核病新发病例的年度报告率从67.1上升至165.1。自1998年起，公共卫生当局采用了世界卫生组织（WHO）颁布的国家病例管理策略（直接观察短程疗法，DOTS）来控制结核病。DOTS的预期目标包括使新发现的痰涂片阳性肺结核（PTB +）病例患者的治愈率>85%，且PTB +病例占所有成人PTB病例的>65%。对2000 - 2002年期间收集的监测数据进行分析，以评估在实现这些目标方面取得的进展，并确定与特定治疗结果相关的因素。
监测数据包括以下关于新报告的PTB病例患者的不可识别信息：发病日期和开始治疗日期；诊断方法；治疗结果；艾滋病毒感染状况；以及选定的人口统计学、社会经济和行为特征。治愈率和PTB +病例的比例是根据WHO发布的DOTS指南中概述的结核病病例定义和治疗结果分类格式计算得出的。计算发病率的分母数据来自哈萨克斯坦国家统计局。使用Epi Info 3.2版本进行逻辑回归分析，以调查与治疗结果相关的因素。
2000 - 2002年期间，哈萨克斯坦共检测到65,011例新的PTB病例。全国每10万人口的平均年度报告率为146.0；各省份的报告率有所不同（范围：65.1 - 274.0）。新发现的PTB +病例的全国治愈率为72.2%；各省份的治愈率有所不同（范围：65% - 81%）。在2000 - 2002年期间的59,905例成人PTB病例中，共有26,804例（44.7%）为PTB +。新的PTB +病例的不良治疗结果与酗酒、无家可归和先前入狱有关。
新的PTB +病例的治愈率以及所有成人PTB病例中PTB +病例的比例均低于目标值。这在一定程度上可能是由于1998年采用了DOTS。改善项目指标需要评估检测工作、实验室诊断能力以及对治疗方案的依从性，特别是在发病率高的省份以及治疗结果不良风险高的人群中。
