Cazabon Danielle, Alsdurf Hannah, Satyanarayana Srinath, Nathavitharana Ruvandhi, Subbaraman Ramnath, Daftary Amrita, Pai Madhukar
McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada.
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Int J Infect Dis. 2017 Mar;56:111-116. doi: 10.1016/j.ijid.2016.10.016. Epub 2016 Oct 26.
Despite the high coverage of directly observed treatment short-course (DOTS), tuberculosis (TB) continues to affect 10.4 million people each year, and kills 1.8 million. High TB mortality, the large number of missing TB cases, the emergence of severe forms of drug resistance, and the slow decline in TB incidence indicate that merely expanding the coverage of TB services is insufficient to end the epidemic. In the era of the End TB Strategy, we need to think beyond coverage and start focusing on the quality of TB care that is routinely offered to patients in high burden countries, in both public and private sectors. In this review, current evidence on the quality of TB care in high burden countries, major gaps in the quality of care, and some novel efforts to measure and improve the quality of care are described. Based on systematic reviews on the quality of TB care or surrogates of quality (e.g., TB diagnostic delays), analyses of TB care cascades, and newer studies that directly measure quality of care, it is shown that the quality of care in both the public and private sector falls short of international standards and urgently needs improvement. National TB programs will therefore need to systematically measure and improve quality of TB care and invest in quality improvement programs.
尽管直接观察治疗短程疗法（DOTS）的覆盖率很高，但结核病每年仍继续影响1040万人，并导致180万人死亡。结核病死亡率高、大量结核病病例失访、严重耐药形式的出现以及结核病发病率下降缓慢，表明仅仅扩大结核病服务的覆盖率不足以终结这一流行病。在终结结核病战略时代，我们需要超越覆盖率进行思考，开始关注在高负担国家向公共和私营部门患者常规提供的结核病治疗质量。在这篇综述中，描述了高负担国家结核病治疗质量的现有证据、治疗质量方面的主要差距以及一些衡量和提高治疗质量的新举措。基于对结核病治疗质量或质量替代指标（如结核病诊断延误）的系统评价、结核病治疗流程分析以及直接衡量治疗质量的最新研究，结果表明，公共和私营部门的治疗质量均未达到国际标准，迫切需要改进。因此，国家结核病规划将需要系统地衡量和提高结核病治疗质量，并投资于质量改进项目。
