Division of TB Elimination, U,S, Centers for Disease Control and Prevention, Atlanta, GA, USA.
BMC Public Health. 2011 Jul 11;11:550. doi: 10.1186/1471-2458-11-550.
In 2005, Rwanda drafted a national TB/HIV policy and began scaling-up collaborative TB/HIV activities. Prior to the scale-up, we evaluated existing TB/HIV practices, possible barriers to policy and programmatic implementation, and patient treatment outcomes. We then used our evaluation data as a baseline for evaluating the national scale-up of collaborative TB/HIV activities from 2005 through 2009.
Our baseline evaluation included a cross-sectional evaluation of 23/161 TB clinics. We conducted structured interviews with patients and clinic staff and reviewed TB registers and patient records to assess HIV testing practices, provision of HIV care and treatment for people with TB that tested positive for HIV, and patients' TB treatment outcomes. Following our baseline evaluation, we used nationally representative TB/HIV surveillance data to monitor the scale-up of collaborative TB/HIV activities
Of 207 patients interviewed, 76% were offered HIV testing, 99% accepted, and 49% reported positive test results. Of 40 staff interviewed, 68% reported offering HIV testing to >50% of patients. From 2005-2009, scaled-up TB/HIV activities resulted in increased HIV testing of patients with TB (69% to 97%) and provision of cotrimoxazole (15% to 92%) and antiretroviral therapy (13% to 49%) for patients with TB disease and HIV infection (TB/HIV). The risk of death among patients with TB/HIV relative to patients with TB not infected with HIV declined from 2005 (RR = 6.1, 95%CI 2.6, 14.0) to 2007 (RR = 1.8, 95%CI 1.68, 1.94).
Our baseline evaluation highlighted that staff and patients were receptive to HIV testing. However, expanded access to testing, care, and treatment was needed based on the proportion of patients with TB having unknown HIV status and the high rate of HIV infection and poorer TB treatment outcomes for patients with TB/HIV. Following our evaluation, scale-up of TB/HIV services resulted in almost all patients with TB knowing their HIV status. Scale-up also resulted in dramatic increases in the uptake of lifesaving HIV care and treatment coinciding with a decline in the risk of death among patients with TB/HIV.
2005 年，卢旺达起草了国家结核病/艾滋病防治政策，并开始扩大结核病/艾滋病防治合作活动。在扩大合作活动之前，我们对现有的结核病/艾滋病防治措施进行了评估，分析了政策和规划实施的可能障碍，以及患者的治疗结果。然后，我们利用评估数据作为基线，评估 2005 年至 2009 年期间国家结核病/艾滋病防治合作活动的扩大情况。
我们的基线评估包括对 23/161 个结核病诊所进行的横断面评估。我们对患者和诊所工作人员进行了结构式访谈，并查阅了结核病登记册和患者记录，以评估 HIV 检测、为 HIV 检测阳性的结核病患者提供艾滋病毒护理和治疗以及患者结核病治疗结果方面的情况。在基线评估之后，我们利用全国结核病/艾滋病监测数据来监测结核病/艾滋病防治合作活动的扩大情况。
在接受访谈的 207 名患者中，76%的人接受了 HIV 检测，99%的人接受了检测，49%的人报告检测结果呈阳性。在接受访谈的 40 名工作人员中，68%的人报告说，他们为 50%以上的患者提供了 HIV 检测。2005 年至 2009 年期间，结核病/艾滋病防治合作活动的扩大使结核病患者的 HIV 检测率（从 69%增加到 97%）以及结核病合并 HIV 感染患者的复方新诺明（15%增加到 92%）和抗逆转录病毒治疗（13%增加到 49%）有所增加。与未感染 HIV 的结核病患者相比，结核病合并 HIV 感染患者的死亡风险从 2005 年（RR=6.1，95%CI 2.6，14.0）下降到 2007 年（RR=1.8，95%CI 1.68，1.94）。
我们的基线评估表明，工作人员和患者都愿意接受 HIV 检测。然而，根据结核病患者中 HIV 检测结果未知的比例以及 HIV 感染率较高且结核病合并 HIV 感染患者的结核病治疗结果较差的情况，需要扩大检测、护理和治疗的机会。在评估之后，结核病/艾滋病防治服务的扩大使几乎所有的结核病患者都了解了自己的 HIV 状况。扩大服务范围还显著增加了挽救生命的艾滋病毒护理和治疗的比例，同时降低了结核病合并 HIV 感染患者的死亡风险。
