Ahiko Tadayuki
Yamagata Prefectural Institute of Public Health, 1-6-6, Tokamachi, Yamagata-shi, Yamagata 990-0031 Japan.
Kekkaku. 2007 Feb;82(2):119-23.
The DOTS strategy promoted by the World Health Organization (WHO) was applied in 183 countries in 2004. The DOTS coverage, defined as the percentage of the population living in areas where health services have adopted DOTS, was 83% globally in 2004, but it was 71% in Japan. The global 2005 targets for tuberculosis (TB) control are to detect at least 70% of infectious TB cases and cure 85% of those cases detected. According to the most recent WHO annual report, the DOTS case detection rate in 2004 was 45% in Japan whereas the global average of it was 53%. The treatment success rate, defined as the percentage of patients (in the 2003 cohort) who are cured or who complete treatment, was 82% globally, but it was 76% in Japan. This relatively low achievement is attributed to the fact that public health centers in some districts operated insufficient monitoring system for evaluation of the treatment outcome by cohort analysis. However, the treatment success rate will not be improved easily because more than half of new TB patients in Japan are old people who tend to have various complications. The Ministry of Health, Labour and Welfare demonstrated the framework of the DOTS Japan version in 2003 to promote the DOTS strategy with collaboration between hospitals, public health centers and welfare organization. The new strategy includes the program for treatment of TB inpatients and the community-based program for outpatients. The latter program called "community DOTS" is classified into three types according to the risk of treatment interruption with an individual patient. The Japanese Society for Tuberculosis should urge the government (at central and regional levels) to enhance political commitment to accelerate activities for TB elimination. It is necessary that the central government build a new public funding system to improve the cure rate under the DOTS Japan version. The local government should strengthen the function of public health centers not only to secure the quality of monitoring system for evaluation of the treatment outcome but to develop human resources who are able to collaborate with public health nurses in promoting the community-based DOTS program.
世界卫生组织（WHO）推行的直接督导下的短程化疗（DOTS）策略于2004年在183个国家得到应用。DOTS覆盖率定义为生活在卫生服务机构采用DOTS地区的人口百分比，2004年全球DOTS覆盖率为83%，但在日本为71%。2005年全球结核病（TB）控制目标是至少发现70%的传染性结核病病例，并治愈其中85%的病例。根据世界卫生组织最新年度报告，2004年日本DOTS病例发现率为45%，而全球平均水平为53%。治疗成功率定义为（2003年队列中的）治愈或完成治疗的患者百分比，全球为82%，但在日本为76%。这一相对较低的成果归因于一些地区的公共卫生中心对通过队列分析评估治疗结果的监测系统运作不足。然而，治疗成功率不易提高，因为日本超过一半的新结核病患者是老年人，他们往往有各种并发症。厚生劳动省在2003年展示了日本版DOTS的框架，以通过医院、公共卫生中心和福利组织之间的合作来推广DOTS策略。新策略包括结核病住院患者治疗项目和基于社区的门诊患者项目。后一个项目称为“社区DOTS”，根据个体患者治疗中断风险分为三种类型。日本结核病协会应敦促政府（中央和地方层面）加强政治承诺，以加速消除结核病的活动。中央政府有必要建立新的公共资金系统，以提高日本版DOTS下的治愈率。地方政府应加强公共卫生中心的职能，不仅要确保评估治疗结果的监测系统质量，还要培养能够与公共卫生护士合作推广基于社区的DOTS项目的人力资源。
