Stop TB Department, World Health Organization, Geneva, Switzerland.
Lancet Infect Dis. 2013 Aug;13(8):690-7. doi: 10.1016/S1473-3099(13)70130-0. Epub 2013 Jun 4.
The prospects for global tuberculosis control in the near future will be determined by the effectiveness of the response of countries to their burden of multidrug-resistant (MDR; resistance to, at least, isoniazid and rifampicin) tuberculosis. During the 2009 World Health Assembly, countries committed to achieve universal access to MDR-tuberculosis care by 2015. We assessed the progress towards the 2015 targets achieved by countries accounting for 90% of the estimated MDR-tuberculosis cases in the world in 2011.
We analysed data reported to WHO by 30 countries expected to have more than 1000 MDR-tuberculosis cases among notified patients with pulmonary tuberculosis in 2011.
In the 30 countries, 18% of the estimated MDR-tuberculosis cases were enrolled on treatment in 2011. Belarus, Brazil, Kazakhstan, Peru, South Africa, and Ukraine each detected and enrolled on treatment more than 50% of their estimated cases of MDR-tuberculosis. In Ethiopia, India, Indonesia, the Philippines, and Russia, enrolments increased steadily between 2009 and 2011 with a mean yearly change greater than 50%: however, in these countries enrolment in 2011 was low, ranging from 4% to 43% of the estimated cases. In the remaining countries (Afghanistan, Angola, Azerbaijan, Bangladesh, China, Democratic Republic of the Congo, Kenya, Kyrgyzstan, Moldova, Mozambique, Burma, Nepal, Nigeria, North Korea, Pakistan, South Korea, Thailand, Uzbekistan, and Vietnam) progress in detection and enrolment was slower. In 23 countries, a median of 53% (IQR 41-71) patients with MDR-tuberculosis successfully completed their treatment after starting it in 2008-09.
Six countries (Belarus, Brazil, Kazakhstan, Peru, South Africa, and Ukraine) can achieve universal access to MDR-tuberculosis care by 2015 should they sustain their current pace of progress. In other countries a radical scale-up will be needed for them to have an effect on their MDR-tuberculosis burden. Unless barriers to diagnosis and successful treatment are urgently overcome, and new technologies in diagnostics and treatment effectively implemented, the global targets for 2015 are unlikely be achieved.
WHO.
近期全球结核病控制的前景将取决于各国对耐多药结核病（至少对异烟肼和利福平耐药）负担的应对效果。在 2009 年世界卫生大会上，各国承诺到 2015 年实现普遍获得耐多药结核病治疗。我们评估了在 2011 年占世界估计耐多药结核病病例 90%的 30 个国家实现 2015 年目标的进展情况。
我们分析了 2011 年预计有 1000 多例肺结核新发病例的 30 个国家向世卫组织报告的数据。
在这 30 个国家中，2011 年有 18%的估计耐多药结核病病例被纳入治疗。白俄罗斯、巴西、哈萨克斯坦、秘鲁、南非和乌克兰各自发现并纳入治疗的耐多药结核病病例超过其估计病例的 50%。在埃塞俄比亚、印度、印度尼西亚、菲律宾和俄罗斯，2009 年至 2011 年期间，纳入治疗的人数稳步增加，年平均增长率超过 50%：然而，在这些国家，2011 年的纳入治疗率较低，范围从 4%到 43%的估计病例。在其余国家（阿富汗、安哥拉、阿塞拜疆、孟加拉国、中国、刚果民主共和国、肯尼亚、吉尔吉斯斯坦、摩尔多瓦、莫桑比克、缅甸、尼泊尔、尼日利亚、朝鲜、巴基斯坦、韩国、泰国、乌兹别克斯坦和越南），发现和纳入治疗的进展较慢。在 23 个国家中，中位数为 53%（IQR 41-71）的耐多药结核病患者在 2008-09 年开始治疗后成功完成了治疗。
有 6 个国家（白俄罗斯、巴西、哈萨克斯坦、秘鲁、南非和乌克兰）如果保持目前的进展速度，到 2015 年就能实现普遍获得耐多药结核病治疗。在其他国家，需要大规模扩大规模，才能对耐多药结核病负担产生影响。除非紧急克服诊断和成功治疗的障碍，并有效实施诊断和治疗新技术，否则 2015 年的全球目标不太可能实现。
世卫组织。
