Atun Rifat A, Lebcir Reda M, McKee Martin, Habicht Jarno, Coker Richard J
Centre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
Health Policy. 2007 May;81(2-3):207-17. doi: 10.1016/j.healthpol.2006.05.021. Epub 2006 Jul 18.
In Eastern Europe and Central Asia (ECA) the control of tuberculosis, multidrug resistant tuberculosis (MDRTB) and human immunodeficiency virus (HIV) poses important public health challenges. We used system dynamics simulation to determine impact on cumulative HIV/AIDS, tuberculosis and HIV-associated-tuberculosis deaths, over 20 years, of harm-reduction programmes to reduce needle-sharing and injection-frequency amongst injecting drug users (IDUs) and multidrug resistant tuberculosis (MDRTB) control in a population with an explosive HIV epidemic in IDUs and high MDRTB prevalence. We estimate that the number of HIV-associated-deaths will decline by 30% with effective harm-reduction programmes but double if these are ineffective. In our model, effective MDRTB and HIV control reduces cumulative tuberculosis deaths by 54%, cumulative MDRTB deaths 15-fold and cumulative HIV-associated-tuberculosis-deaths 2-fold. Effective MDRTB control, without effective harm-reduction programmes, only reduce tuberculosis deaths by 22%. However, effective harm-reduction programme with a poor MDRTB control reduce cumulative tuberculosis deaths by 34%, MDRTB by 14% and HIV-associated-tuberculosis by 56%. Even with good control programmes for drug sensitive TB, neglecting harm reduction and MDRTB control will result in 50% more tuberculosis-related deaths than if both are effectively addressed. Effective harm-reduction programmes reduces cumulative deaths from tuberculosis more substantively than effective MDRTB control. Our finding have important policy implications for communicable disease policies in post-Soviet countries, which need to substantially change if they are to effectively address the emerging HIV and MDRTB epidemics.
在东欧和中亚地区，结核病、耐多药结核病以及人类免疫缺陷病毒（HIV）的防控构成了重大的公共卫生挑战。我们运用系统动力学模拟，来确定在注射吸毒者中存在HIV疫情爆发且耐多药结核病患病率较高的人群里，减少共用针头和注射频率的减少伤害项目以及耐多药结核病防控措施，在20年期间对HIV/AIDS、结核病以及HIV相关结核病死亡累积数的影响。我们估计，有效的减少伤害项目将使HIV相关死亡人数减少30%，但如果这些项目无效，死亡人数将翻倍。在我们的模型中，有效的耐多药结核病和HIV防控可使结核病累积死亡人数减少54%，耐多药结核病累积死亡人数减少15倍，HIV相关结核病累积死亡人数减少2倍。有效的耐多药结核病防控，如果没有有效的减少伤害项目，仅能使结核病死亡人数减少22%。然而，有效的减少伤害项目加上较差的耐多药结核病防控，可使结核病累积死亡人数减少34%，耐多药结核病减少14%，HIV相关结核病减少56%。即便对药物敏感结核病有良好的防控项目，但忽视减少伤害和耐多药结核病防控，与有效应对这两者相比，结核病相关死亡人数将多出50%。有效的减少伤害项目比有效的耐多药结核病防控能更实质性地减少结核病累积死亡人数。我们的研究结果对后苏联国家的传染病政策具有重要的政策启示，如果要有效应对新出现的HIV和耐多药结核病疫情，这些政策需要做出重大改变。
