Desmond Tutu HIV Centre, and Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town.
S Afr Med J. 2011 Feb;101(2):111-4. doi: 10.7196/samj.4587.
South Africa's rate of tuberculosis (TB) has increased over the last 20 years, to now having the third-highest TB burden in the world. The TB control programme has primarily focused on effective case management of passively presenting TB cases, and progress has been recorded towards international treatment targets. While outcomes for notified TB cases have improved, this strategy failed to contain the TB epidemic. South Africa has the highest per capita annual risk of TB disease of comparably sized countries globally, and its communities have extremely high TB transmission rates. The rates of TB infection of children and adolescents are now similar to those reported 100 years ago in Europe long before chemotherapy became available. High rates of HIV testing of TB patients in Cape Town allows analysis of TB notification data stratified by age, type of TB and HIV status, and a better understanding of TB epidemiology. TB infection prevalence data from Cape Town communities allow estimation of the prevailing force of TB infection and, together with TB notification and prevalence data, the effective number of secondary infections and case finding proportions can be estimated. This better understanding of the major drivers of the TB epidemic allows reasons to be identified for failure of the present strategy. New control strategies can also be identified, that must be accompanied by novel TB control targets.
在过去的 20 年里，南非的结核病（TB）发病率有所上升，现在是世界上结核病负担第三高的国家。结核病控制规划主要侧重于被动呈现的结核病病例的有效病例管理，并且在实现国际治疗目标方面取得了进展。虽然已通报结核病病例的结果有所改善，但这一策略未能遏制结核病的流行。南非是全球可比国家中人均年结核病发病率最高的国家，其社区的结核病传播率极高。儿童和青少年的结核病感染率现在与 100 年前在化疗出现之前的欧洲报告的水平相似。开普敦对结核病患者进行的高比例 HIV 检测，使我们能够按年龄、结核病类型和 HIV 状况对结核病通报数据进行分层分析，并更好地了解结核病的流行病学。开普敦社区的结核病感染流行率数据可以估计当前结核病感染的普遍程度，结合结核病通报和流行率数据，可以估计继发感染的有效数量和病例发现比例。这种对结核病流行的主要驱动因素的更好理解，使我们能够找出当前策略失败的原因。也可以确定新的控制策略，而这些策略必须伴随着新的结核病控制目标。
