Havlir Diane V, Getahun Haileyesus, Sanne Ian, Nunn Paul
Department of Medicine, University of California, San Francisco, USA.
JAMA. 2008 Jul 23;300(4):423-30. doi: 10.1001/jama.300.4.423.
Tuberculosis (TB) and the emerging multidrug-resistant TB epidemic represent major challenges to human immunodeficiency virus (HIV) care and treatment programs in resource-limited settings. Tuberculosis is a major cause of mortality among patients with HIV and poses a risk throughout the course of HIV disease, even after successful initiation of antiretroviral therapy (ART). Progress in the implementation of activities directed at reducing TB burden in the HIV population lags far behind global targets. HIV programs designed for longitudinal care are ideally suited to implement TB control measures and have no option but to address TB vigorously to save patient lives, to safeguard the massive investment in HIV treatment, and to curb the global TB burden. We propose a framework of strategic actions for HIV care programs to optimally integrate TB into their services. The core activities of this framework include intensified TB case finding, treatment of TB, isoniazid preventive treatment, infection control, administration of ART, TB recording and reporting, and joint efforts of HIV and TB programs at the national and local levels.
结核病（TB）以及新出现的耐多药结核病疫情对资源有限环境下的人类免疫缺陷病毒（HIV）护理和治疗项目构成了重大挑战。结核病是HIV患者死亡的主要原因，并且在HIV疾病的整个过程中都构成风险，即使在成功启动抗逆转录病毒治疗（ART）之后也是如此。在实施旨在减轻HIV人群结核病负担的活动方面，进展远远落后于全球目标。为长期护理设计的HIV项目非常适合实施结核病控制措施，并且别无选择，只能大力应对结核病，以挽救患者生命、保护对HIV治疗的巨额投资并遏制全球结核病负担。我们提出了一个战略行动框架，以使HIV护理项目能够最佳地将结核病纳入其服务中。该框架的核心活动包括强化结核病病例发现、结核病治疗、异烟肼预防性治疗、感染控制、ART管理、结核病记录和报告，以及国家和地方层面HIV和结核病项目的共同努力。
