需要高覆盖率的高效抗逆转录病毒疗法（HAART）才能大幅减少结核病死亡人数：系统动力学模拟

High coverage with HAART is required to substantially reduce the number of deaths from tuberculosis: system dynamics simulation.

作者信息

Atun Rifat A, Lebcir Reda M, Drobniewski Francis, McKee Martin, Coker Richard J

机构信息

Centre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London, UK.

出版信息

Int J STD AIDS. 2007 Apr;18(4):267-73. doi: 10.1258/095646207780659024.

DOI:10.1258/095646207780659024

PMID:17509178

Abstract

We used a system dynamics simulation model of the transmission dynamics of drug-sensitive tuberculosis (DSTB), multidrug-resistant tuberculosis (MDRTB) and HIV to estimate the impact of coverage with highly active antiretroviral therapy (HAART) and different cure rates for MDRTB in settings of explosive HIV epidemics and high MDRTB levels. Population coverage levels at 0%, 25%, 50%, 75% and 100% for HAART, and 5% and 80% of MDRTB treatment cure rates were simulated over a 10-year period and cumulative deaths from tuberculosis and HIV-associated tuberculosis were estimated for populations with latent tuberculosis, DSTB, MDRTB, HIV and HIV-associated tuberculosis. Depending on levels of HAART population coverage, increasing MDRTB cure rates from 5% to 80% reduces cumulative tuberculosis deaths by 1% and 13%. High population coverage with HAART (75% or higher), allied with high MDRTB cure rates, reduces cumulative deaths by 60%, with limited impact below this level. High coverage with HAART is required to substantially reduce the number of deaths from tuberculosis.

摘要

我们使用了一个关于药物敏感型结核病（DSTB）、耐多药结核病（MDRTB）和艾滋病毒传播动力学的系统动力学模拟模型，以评估在艾滋病毒疫情爆发且耐多药结核病水平较高的情况下，高效抗逆转录病毒疗法（HAART）的覆盖率以及耐多药结核病的不同治愈率所产生的影响。在10年期间模拟了HAART的人群覆盖率分别为0%、25%、50%、75%和100%，以及耐多药结核病治疗治愈率为5%和80%的情况，并估计了潜伏性结核病、药物敏感型结核病、耐多药结核病、艾滋病毒和艾滋病毒相关结核病患者人群中结核病及艾滋病毒相关结核病的累积死亡人数。根据HAART的人群覆盖率水平，将耐多药结核病治愈率从5%提高到80%，可使结核病累积死亡人数减少1%和13%。HAART的高人群覆盖率（75%或更高）与耐多药结核病的高治愈率相结合，可使累积死亡人数减少60%，低于此水平时影响有限。需要HAART的高覆盖率才能大幅减少结核病死亡人数。