Nair Nani, Cooreman Erwin
Regional Advisor (TB), WHO South-East Asia Regional Office, New Delhi.
J Commun Dis. 2006 Mar;38(3):185-90.
DOTS has expanded rapidly in the South-East Asia Region over the period of the Partnership's first Global Plan (2001-2005), with almost 100% geographical coverage achieved in 2005. All countries have made impressive progress in improving coverage and quality. This progress has been made possible through strong political commitment and large investments in TB control for improved infrastructure, reliable drug supply, increased staffing, improved laboratory services, and intensified training and supervision. Accomplishing the objectives outlined in this document will require sustaining the progress in all countries and particularly in the five high burden countries for achieving major regional and global impact. National TB programmes will need to be supported to maintain or surpass the 70% case detection and 85% treatment success rates. The achievement of the TB-related targets linked to the MDGs will also depend on how effectively initiatives such as DOTS-Plus, PPM DOTS and interventions for TB/ HIV among others, are implemented. National governments and development partners must fulfill their commitments to mobilizing and sustaining adequate resources to support the full range of activities envisaged. The benefits of full and effective implementation of all the planned interventions would be substantial. These will result in 20 to 25 million TB cases being treated in DOTS program mes and more than 150 000 drug-resistant cases receiving treatment through DOTS-Plus during the period 2006-2015. In addition, at least 250 000 HIV-infected TB patients may also receive anti-retroviral therapy. As a consequence, the prevalence of TB is expected to fall below 175/100 000 and the number of TB deaths is expected to fall to between 100 000 and 150 000 per year. There would also be substantial economic benefits given that TB disproportionately affects adults in their most productive years. Considering these aspects, it is expected that the TB incidence will decline significantly during this period so that the Millennium Development Goals would be met by or ahead of 2015.
在伙伴关系的首个全球计划(2001 - 2005年)期间,直接督导下的短程化疗(DOTS)在东南亚区域迅速扩展,2005年实现了近100%的地理覆盖。所有国家在提高覆盖率和质量方面都取得了令人瞩目的进展。通过强有力的政治承诺以及对结核病控制的大量投资,包括改善基础设施、确保可靠的药品供应、增加人员配备、改善实验室服务以及强化培训和监督,才得以取得这一进展。要实现本文件中概述的目标,需要在所有国家,特别是五个高负担国家保持这一进展,以产生重大的区域和全球影响。各国结核病规划需要得到支持,以维持或超过70%的病例发现率和85%的治疗成功率。与千年发展目标相关的结核病相关目标的实现还将取决于诸如强化DOTS、公私混合DOTS以及结核病/艾滋病干预措施等举措的实施效果。各国政府和发展伙伴必须履行其承诺,调动并持续提供充足资源,以支持所设想的各类活动。全面有效地实施所有计划干预措施将带来巨大益处。这将导致在2006 - 2015年期间,有2000万至2500万结核病病例在DOTS项目中得到治疗,超过15万耐药病例通过强化DOTS得到治疗。此外,至少25万感染艾滋病毒的结核病患者也可能接受抗逆转录病毒治疗。因此,预计结核病患病率将降至每10万人175例以下,每年结核病死亡人数预计将降至10万至15万之间。鉴于结核病对处于生产力最高年龄段的成年人影响尤为严重,还将带来巨大的经济效益。考虑到这些方面,预计在此期间结核病发病率将大幅下降,从而在2015年或之前实现千年发展目标。