在马拉维农村地区扩大抗逆转录病毒治疗与结核病病例报告减少相关。

Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi.

机构信息

Médecins Sans Frontières (MSF), Medical Department (Operational Research), MSF-Luxembourg, Brussels Operational Centre, Luxembourg.

出版信息

Int J Tuberc Lung Dis. 2011 Jul;15(7):933-7. doi: 10.5588/ijtld.10.0666.

DOI:10.5588/ijtld.10.0666

PMID:21682967

Abstract

OBJECTIVE

To report on the trends in new and recurrent tuberculosis (TB) case notifications in a rural district of Malawi that has embarked on large-scale roll-out of antiretroviral treatment (ART).

METHODS

Descriptive study analysing TB case notification and ART enrolment data between 2002 and 2009.

RESULTS

There were a total of 10,070 new and 755 recurrent TB cases. ART scale-up started in 2003, and by 2007 an estimated 80% ART coverage had been achieved and was sustained thereafter. For new TB cases, an initial increase in case notifications in the first years after starting ART (2002-2005) was followed by a highly significant and sustained decline from 259 to 173 TB cases per 100,000 population (χ(2) for trend 261, P < 0.001, cumulative reduction for 2005-2009 = 33%, 95%CI 27-39). For recurrent TB, the initial increase was followed by a significant drop, from 20 to 15 cases/100,000 (χ(2) for linear trend = 8.3, P = 0.004, constituting a 25% (95%CI 9-49) cumulative reduction between 2006 and 2009. From 2005 to 2009, ART averted an estimated 1164 (95%CI 847-1480) new TB cases and 78 (95%CI 23-151) recurrent TB cases.

CONCLUSIONS

High ART implementation coverage is associated with a very significant declining trend in new and recurrent TB case notifications at population level.

摘要

目的

报告在马拉维一个农村地区开展大规模抗逆转录病毒治疗（ART）以来，新发病例和复发病例的结核病（TB）报告趋势。

方法

对 2002 年至 2009 年期间的结核病病例报告和 ART 登记数据进行描述性研究。

结果

共有 10070 例新发和 755 例复发病例。ART 推广始于 2003 年，到 2007 年，估计有 80%的 ART 覆盖率，并在此后保持稳定。对于新发病例，在开始 ART 的最初几年中，病例报告数量有所增加（2002-2005 年），随后呈现出显著且持续下降趋势，从每 10 万人中 259 例降至 173 例（趋势检验 χ(2)261，P<0.001，2005-2009 年累计减少 33%，95%CI 27-39）。对于复发病例，最初增加后显著下降，从每 10 万人 20 例降至 15 例（线性趋势检验 χ(2)8.3，P=0.004，2006 年至 2009 年累计减少 25%，95%CI 9-49）。从 2005 年至 2009 年，ART 避免了约 1164 例（95%CI 847-1480）新发病例和 78 例（95%CI 23-151）复发病例。