Mistry Nerges, Tolani Monica, Osrin David
The Foundation for Medical Research, 84A RG Thadani Marg, Worli, Mumbai 400 018, Maharashtra, India.
Center for International Health and Development, UCL Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK.
Oper Res Health Care. 2012 Jun;1(2-3):45-53. doi: 10.1016/j.orhc.2012.06.001.
Operations research (OR) is well established in India and is also a prominent feature of the global and local agendas for tuberculosis (TB) control. India accounts for a quarter of the global burden of TB and of new cases. Multidrug-resistant TB is a significant problem in Mumbai, India's most populous city, and there have been recent reports of totally resistant TB. Much thought has been given to the role of OR in addressing programmatic challenges, by both international partnerships and India's Revised National TB Control Programme. We attempt to summarize the major challenges to TB control in Mumbai, with an emphasis on drug resistance. Specific challenges include diagnosis of TB and defining cure, detecting drug resistant TB, multiple sources of health care in the private, public and informal sectors, co-infection with human immunodeficiency virus (HIV) and a concurrent epidemic of non-communicable diseases, suboptimal prescribing practices, and infection control. We propose a local agenda for OR: modeling the effects of newer technologies, active case detection, and changes in timing of activities, and mapping hotspots and contact networks; modeling the effects of drug control, changing the balance of ambulatory and inpatient care, and adverse drug reactions; modeling the effects of integration of TB and HIV diagnosis and management, and preventive drug therapy; and modeling the effects of initiatives to improve infection control.
运筹学（OR）在印度已得到充分确立，并且也是全球和地方结核病（TB）控制议程的一个显著特征。印度承担了全球四分之一的结核病负担和新增病例。耐多药结核病是印度人口最多的城市孟买的一个重大问题，最近有关于完全耐药结核病的报道。国际伙伴关系和印度修订后的国家结核病控制规划都对运筹学在应对规划挑战方面的作用进行了深入思考。我们试图总结孟买结核病控制面临的主要挑战，重点是耐药性。具体挑战包括结核病的诊断和治愈标准的界定、耐多药结核病的检测、私营、公共和非正规部门多种医疗保健来源、与人类免疫缺陷病毒（HIV）的合并感染以及非传染性疾病的并发流行、不合理的处方做法以及感染控制。我们提出了一个运筹学的地方议程：对新技术的效果、主动病例发现以及活动时间安排的变化进行建模，绘制热点地区和接触网络；对药物控制的效果、改变门诊和住院治疗的平衡以及药物不良反应进行建模；对结核病和HIV诊断与管理的整合以及预防性药物治疗的效果进行建模；以及对改善感染控制措施的效果进行建模。
