Collaboration for Research on Equity and Systems in TB and HIV-AIDS (CRESTHA), Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, UK.
Int J Tuberc Lung Dis. 2011 Jul;15(7):862-70. doi: 10.5588/ijtld.11.0161.
Within countries, poorer populations have greater health needs and less access to good medical care than better-off populations. This is particularly true for tuberculosis (TB), the archetypal disease of poverty. Innovations also tend to become available to better-off populations well before they become available to those who need them the most. In a new era of innovations for TB diagnosis and treatment, it is increasingly important not only to be sure that these innovations can work in terms of accuracy and efficacy, but also that they will work, especially for the poor. We argue that after an innovation or a group of innovations has been endorsed, based on demonstrated accuracy and/or efficacy, introduction into routine practice should proceed through implementation by research. Cluster-randomised pragmatic trials are suited to this approach, and permit the prospective collection of evidence needed for full impact assessment according to a previously published framework. The novel approach of linking transmission modelling with operational modelling provides a methodology for expanding and enhancing the range of evidence, and can be used alongside evidence from pragmatic implementation trials. This evidence from routine practice should then be used to ensure that innovations in TB control are used for positive action for all, and particularly the poor.
在国家内部，较贫困人群的健康需求更大，但获得良好医疗保健的机会却比富裕人群少。这在结核病（TB）这种典型的贫困病中尤为明显。创新技术往往也会先在富裕人群中得到应用，然后才会在最需要的人群中得到应用。在结核病诊断和治疗的创新新时代，不仅要确保这些创新在准确性和疗效方面能够发挥作用，而且要确保它们能够发挥作用，尤其是对贫困人口。我们认为，在一项或一组创新技术得到验证，具有准确性和/或疗效之后，应该通过研究实施来推进其常规应用。基于群组的实用型随机试验非常适合这种方法，并且可以根据之前发布的框架前瞻性地收集全影响评估所需的证据。将传播建模与操作建模相联系的新方法为扩展和增强证据范围提供了一种方法，可与实用实施试验的证据结合使用。然后，应利用常规实践中的这些证据，确保结核病控制方面的创新能为所有人，特别是贫困人口带来积极影响。
