International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London.
International Union Against Tuberculosis and Lung Disease, Paris, France.
Int J Tuberc Lung Dis. 2019 Dec 1;23(12):1253-1256. doi: 10.5588/ijtld.19.0471. Epub 2019 Nov 21.
The international community has committed to end the tuberculosis (TB) epidemic by 2030. To facilitate the meeting of the global incidence and mortality indicators set by the World Health Organization's End TB Strategy, the Stop TB Partnership launched the three 90-(90)-90 diagnostic and treatment targets in 2014. In this paper, we argue that a 'fourth 90'-Ensuring that 90% of all people successfully completing treatment for TB can have a good health-related quality of life'-should be considered. Many individuals who successfully complete anti-TB treatment are burdened with lifelong comorbidities-human immunodeficiency virus (HIV) and diabetes mellitus, obstructive and restrictive lung disease, involving lung destruction, cavitation, fibrosis and bronchiectasis, that either pre-existed or developed as a result of TB (e.g., chronic pulmonary aspergillosis), permanent disabilities such as hearing loss resulting from second-line anti-TB drugs, and mental health disorders. These need to be identified during TB treatment and appropriate care and support provided after anti-TB treatment is successfully completed. A 'fourth 90' has also been proposed for the UNAIDS 90-90-90 targets similar in scope to what is being suggested here for TB. Adoption by both HIV and TB control programmes would highlight the current focus on integrated person- and family-centred services.
国际社会承诺到 2030 年终结结核病（TB）流行。为了促进实现世界卫生组织《终止结核病战略》所设定的全球发病率和死亡率指标，遏制结核病伙伴关系于 2014 年推出了三个 90-（90）-90 诊断和治疗目标。在本文中，我们提出应考虑第四个 90-确保 90%成功完成结核病治疗的人能够拥有良好的健康相关生活质量。许多成功完成抗结核治疗的人都承受着终身合并症的负担——人类免疫缺陷病毒（HIV）和糖尿病、阻塞性和限制性肺病，涉及肺部破坏、空洞形成、纤维化和支气管扩张，这些疾病要么是在结核病之前存在，要么是由结核病引起的（例如慢性肺曲霉病），永久性残疾如二线抗结核药物导致的听力损失，以及心理健康障碍。这些需要在结核病治疗期间识别，并在成功完成抗结核治疗后提供适当的护理和支持。UNAIDS 的 90-90-90 目标也提出了第四个 90，其范围与这里为结核病建议的范围相似。艾滋病毒和结核病控制规划的采用将突出目前对以人为中心和家庭为中心的综合服务的关注。
