Naidoo Pren, Theron Grant, Rangaka Molebogeng X, Chihota Violet N, Vaughan Louise, Brey Zameer O, Pillay Yogan
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Bill and Melinda Gates Foundation, Seattle, Washington.
J Infect Dis. 2017 Nov 6;216(suppl_7):S702-S713. doi: 10.1093/infdis/jix335.
While tuberculosis incidence and mortality are declining in South Africa, meeting the goals of the End TB Strategy requires an invigorated programmatic response informed by accurate data. Enumerating the losses at each step in the care cascade enables appropriate targeting of interventions and resources.
We estimated the tuberculosis burden; the number and proportion of individuals with tuberculosis who accessed tests, had tuberculosis diagnosed, initiated treatment, and successfully completed treatment for all tuberculosis cases, for those with drug-susceptible tuberculosis (including human immunodeficiency virus (HIV)-coinfected cases) and rifampicin-resistant tuberculosis. Estimates were derived from national electronic tuberculosis register data, laboratory data, and published studies.
The overall tuberculosis burden was estimated to be 532005 cases (range, 333760-764480 cases), with successful completion of treatment in 53% of cases. Losses occurred at multiple steps: 5% at test access, 13% at diagnosis, 12% at treatment initiation, and 17% at successful treatment completion. Overall losses were similar among all drug-susceptible cases and those with HIV coinfection (54% and 52%, respectively, successfully completed treatment). Losses were substantially higher among rifampicin- resistant cases, with only 22% successfully completing treatment.
Although the vast majority of individuals with tuberculosis engaged the public health system, just over half were successfully treated. Urgent efforts are required to improve implementation of existing policies and protocols to close gaps in tuberculosis diagnosis, treatment initiation, and successful treatment completion.
虽然南非的结核病发病率和死亡率正在下降，但要实现终止结核病战略的目标，需要根据准确数据采取更有力的规划应对措施。在治疗流程的每一步计算损失情况有助于合理确定干预措施和资源的目标。
我们估计了结核病负担；针对所有结核病病例、耐多药结核病病例（包括合并感染人类免疫缺陷病毒（HIV）的病例）和利福平耐药结核病病例，计算了接受检测、被诊断为结核病、开始治疗以及成功完成治疗的结核病患者人数及比例。估计值来自国家结核病电子登记数据、实验室数据和已发表的研究。
总体结核病负担估计为532005例（范围为333760 - 764480例），53%的病例成功完成治疗。在多个环节出现损失：检测环节损失5%，诊断环节损失13%，治疗启动环节损失12%，成功完成治疗环节损失17%。所有药物敏感病例和合并感染HIV的病例的总体损失相似（分别为54%和52%成功完成治疗）。利福平耐药病例的损失要高得多，只有22%成功完成治疗。
虽然绝大多数结核病患者参与了公共卫生系统，但只有略超过一半得到成功治疗。需要紧急努力改进现有政策和方案的实施，以弥合结核病诊断及治疗启动和成功完成治疗方面的差距。
