Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada.
Int J Tuberc Lung Dis. 2011 May;15(5):613-9. doi: 10.5588/ijtld.10.0199.
National tuberculosis (TB) programmes (NTPs) in 100 countries.
To evaluate the relationship between the estimated prevalence of multidrug resistance in previously untreated TB cases and policies regarding sales and distribution of TB drugs, particularly rifampicin (RMP).
Questionnaire survey of national TB drug control policies, completed by NTP managers. Results were correlated with recent World Health Organization estimates of prevalence of drug resistance in new cases of TB.
Questionnaires were received from 100 countries, including 88 low- and middle-income countries (LMICs) and 17 of the 22 high-burden countries. Current policies were considered adequate in only 40 of the 88 LMICs (45%). A higher prevalence of multidrug resistance was associated with fewer years of free availability of TB drugs from the NTP (P = 0.02) and more years of availability of RMP from providers or pharmacies outside the NTP (P = 0.02). Eleven of the 20 countries with the highest prevalence of multidrug resistance had inadequate policies governing sales and distribution of TB drugs.
These findings suggest that policies regarding sales and distribution of TB drugs should receive more emphasis as part of the global strategy to control drug resistance.
100 个国家的国家结核病规划（NTP）。
评估既往未经治疗的结核病病例中药物耐药估计流行率与结核病药物销售和分发政策（特别是利福平（RMP））之间的关系。
对国家结核病药物控制政策进行问卷调查，由 NTP 管理人员完成。结果与世界卫生组织（WHO）最近对新结核病病例药物耐药流行率的估计相关联。
共收到来自 100 个国家的问卷，其中包括 88 个中低收入国家（LMIC）和 22 个高负担国家中的 17 个。在 88 个 LMIC 中，仅有 40 个（45%）被认为现行政策是充分的。NTP 提供的免费结核病药物可获得年限较短（P=0.02），以及 NTP 以外的提供者或药店可获得 RMP 的年限较长（P=0.02），与药物耐药的更高流行率相关。在药物耐药率最高的 20 个国家中，有 11 个国家的结核病药物销售和分发政策存在不足。
这些发现表明，作为控制耐药性全球战略的一部分，应更加重视结核病药物销售和分发政策。
