Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China.
Int J Tuberc Lung Dis. 2012 Nov;16(11):1433-40. doi: 10.5588/ijtld.12.0080.
To summarise data on the implementation of the DOTS strategy in China in terms of actual observation and treatment adherence, and to review the effectiveness of quality improvement interventions for tuberculosis (TB) control in China.
We included survey studies that reported data on the implementation of DOTS in China and controlled studies that evaluated TB care in specified communities. We excluded studies outside mainland China, pharmacological intervention trials and reviews.
We included 12 survey studies that reported on the performance of TB control services in China. The pooled analysis showed that more than half of TB patients were treated by self-administration (52%) and that only 20% actually had their treatment observed by health workers. We include 85 intervention studies that evaluated the effect of quality improvement interventions. Treatment observers were family members in 37 studies, and health workers in 20 studies. The pooled odds ratio (OR) for cure was 2.48 (95%CI 1.97-3.11, I(2) = 70.9%, P < 0.001); the pooled OR for treatment completion was 2.87 (95%CI 2.23-3.69, I(2) = 66.3%, P < 0.001). Sensitivity analysis found that the estimated treatment effects in meta-analyses using reported and imputed data were much reduced, but still statistically significant.
The proportion of TB patients whose treatment was strictly observed was much lower than reported by official statistics in China. The treatment completion rate was not optimal, which may be an important reason for the reported increases in drug resistance. Community health personnel have become the main work force for TB control in China.
总结中国实施直接督导下的短程化疗（DOTS）策略的数据，包括实际观察和治疗依从性，并回顾中国结核病（TB）控制质量改进干预的效果。
我们纳入了报告中国 DOTS 实施情况的调查研究和评估特定社区 TB 护理的对照研究。我们排除了中国大陆以外的研究、药理学干预试验和综述。
我们纳入了 12 项报告中国 TB 控制服务表现的调查研究。汇总分析显示，超过一半的 TB 患者接受自我管理治疗（52%），只有 20%的患者实际接受了卫生工作者的治疗观察。我们纳入了 85 项评估质量改进干预效果的干预研究。在 37 项研究中，治疗观察者是家庭成员，在 20 项研究中是卫生工作者。治愈率的合并优势比（OR）为 2.48（95%CI 1.97-3.11，I²=70.9%，P<0.001）；治疗完成率的合并 OR 为 2.87（95%CI 2.23-3.69，I²=66.3%，P<0.001）。敏感性分析发现，使用报告和推断数据进行荟萃分析估计的治疗效果大大降低，但仍具有统计学意义。
中国严格观察治疗的 TB 患者比例远低于官方统计报告的比例。治疗完成率不理想，这可能是报告中耐药性增加的一个重要原因。社区卫生人员已成为中国结核病控制的主要工作力量。
