Lung Clinic, Tartu University Clinics, Tartu, Estonia.
Int J Tuberc Lung Dis. 2011 Jul;15(7):892-8. doi: 10.5588/ijtld.10.0601.
To evaluate the impact of countrywide management of tuberculosis (TB) and the availability of second-line drugs (SLDs) on the notification rates of pulmonary TB (PTB) overall and of multidrug-resistant TB (MDR-TB), taking into account human immunodeficiency virus (HIV) co-infection and the national economy in Estonia.
Retrospective analysis of notification rates and treatment outcomes of PTB and MDR-TB during 1998-2006.
The annual notification rates of both PTB and MDR-TB decreased significantly, by on average 3.3 (P = 0.007) and 1.7 (P = 0.008) cases per 100,000 population, respectively. The accelerating impact of SLD availability on the annual decline was significant for both PTB overall and MDR-TB (P = 0.003 and P = 0.025, respectively). During 1998-2006, an increase in TB-HIV co-infection (P = 0.009) significantly affected the notification rates of both PTB overall and MDR-TB (P < 0.001 and P < 0.001, respectively). The negative impact of TB-HIV co-infection was counterbalanced by the availability of SLDs, the decrease in the MDR-TB rate and the increase in gross domestic product (GDP) per capita, as confirmed by multivariate analysis.
Countrywide access to SLDs and the coordinated effect of programmatic conditions can, in parallel with increasing GDP, reverse the increasing notification rates of PTB and MDR-TB in the context of an HIV epidemic.
评估在爱沙尼亚，全国范围内结核病（TB）管理和二线药物（SLD）的可及性对肺结核（PTB）和耐多药结核病（MDR-TB）总发病率的影响，同时考虑到人类免疫缺陷病毒（HIV）合并感染和国民经济情况。
对 1998-2006 年期间 PTB 和 MDR-TB 的发病率和治疗结果进行回顾性分析。
PTB 和 MDR-TB 的年发病率均显著下降，平均分别下降 3.3（P = 0.007）和 1.7（P = 0.008）例/10 万人口。SLD 可用性对 PTB 总发病率和 MDR-TB 发病率的年下降速度的加速影响均具有统计学意义（P = 0.003 和 P = 0.025）。1998-2006 年间，结核病-艾滋病病毒合并感染的增加（P = 0.009）显著影响了 PTB 总发病率和 MDR-TB 发病率（P < 0.001 和 P < 0.001）。通过多元分析证实，TB-HIV 合并感染的负面影响被 SLD 的可及性、MDR-TB 率的下降和人均国内生产总值（GDP）的增加所抵消。
在 HIV 流行的情况下，全国范围内获得 SLD 并与规划条件的协同作用，加上人均 GDP 的增加，可逆转 PTB 和 MDR-TB 发病率不断上升的趋势。
