Critical Path to TB Drug Regimens, Critical Path Institute, 1730 E. River Rd, Tucson, AZ 85718, USA.
Critical Path to TB Drug Regimens, Critical Path Institute, 1730 E. River Rd, Tucson, AZ 85718, USA.
Int J Infect Dis. 2017 Mar;56:10-13. doi: 10.1016/j.ijid.2016.11.007. Epub 2016 Nov 18.
According to the World Health Organization (WHO), 10.4 million people died of tuberculosis (TB) in 2015, and the disease is now the number one cause of death from a preventable infectious disease worldwide. A bold vision is needed from global leaders to end the TB epidemic and plans to this end have been proposed. However enthusiasm must be matched by tangible and achievable goals based on the science and available funding. In order to reach the target and goals set by the WHO End TB Strategy, the challenges for TB eradication need to be addressed. In order to achieve the targets, several areas need to be bolstered, including the requirement to better identify and treat existing drug-susceptible cases and diagnose all the drug-resistant forms of the disease. Although treatment is available for most TB patients, stock-outs and other delays are problematic in some settings, resulting in ongoing transmission, especially for the drug-resistant forms of the disease. Despite the fact that a majority of multidrug-resistant cases are linked to treatment, the cure rate is only 50%, which highlights the need for safer, shorter, and more efficacious drug regimens that are more tolerable to patients. Prospects for a more efficacious vaccine are limited, with no correlates of protection identified; thus the availability of a vaccine by 2025 is highly improbable. Support for instituting infection control methods should be prioritized to subvert transmission while patients seek treatment and care. Finally, more adequate financial mechanisms should be instituted to reduce patient expenditures and support national TB programs. Moreover, funding to support basic science, drug development, clinical trials, vaccine development, diagnostics, and implementation research needs to be secured in order to reduce global TB incidence in the future.
根据世界卫生组织（WHO）的数据，2015 年有 1040 万人死于结核病（TB），结核病目前是全球可预防传染病导致死亡的首要原因。全球领导人需要有一个大胆的愿景来终结结核病流行，并为此提出了计划。然而，热情必须与基于科学和现有资金的切实可行的目标相匹配。为了实现世界卫生组织终结结核病战略设定的目标，需要解决结核病消除面临的挑战。为了实现这些目标，需要加强几个领域，包括更好地识别和治疗现有的耐多药病例，以及诊断所有耐药形式的结核病。虽然大多数结核病患者都有治疗方法，但在某些情况下，药品短缺和其他延迟会导致问题，从而导致持续传播，尤其是耐药形式的结核病。尽管大多数耐多药病例与治疗有关，但治愈率仅为 50%，这凸显了需要更安全、更短、更有效的药物治疗方案，这些方案对患者的耐受性更高。更有效的疫苗前景有限，没有确定的保护相关性；因此，2025 年之前不太可能有疫苗问世。应优先支持实施感染控制方法，以在患者寻求治疗和护理时阻止传播。最后，应建立更充分的财政机制，以减少患者支出并支持国家结核病规划。此外，需要确保为支持基础科学、药物开发、临床试验、疫苗开发、诊断和实施研究提供资金，以减少未来全球结核病的发病率。
