Stallworthy Guy, Dias Hannah Monica, Pai Madhukar
Global TB Programme, World Health Organization, Geneva, Switzerland.
McGill International TB Centre, McGill University, Montreal, Canada.
J Clin Tuberc Other Mycobact Dis. 2020 Jun 13;20:100171. doi: 10.1016/j.jctube.2020.100171. eCollection 2020 Aug.
As countries move towards achieving universal health coverage, efforts to engage all care providers have gained more significance. Over a third of people estimated to have developed TB in 2018 were not detected and notified by national TB programs (NTPs). This gap is more pronounced in countries with large private sectors, especially those with a high burden of TB. Health care providers outside the scope of NTPs, including the private and informal sector, are often the first point of care for TB patients. However, these providers are not fully engaged despite evidence from country experiences and projects that demonstrate increased detection and good treatment outcomes through publicprivate mix (PPM) approaches. While there are often concerns about quality of care in public facilities, there is also increasing evidence that quality of TB care in the private sector falls short of international standards in many places and urgently needs improvement. Failure to engage the full range of health care providers for TB has serious consequences in terms of access to quality care, resulting in increased transmission as a result of delayed diagnosis and treatment; excess mortality and morbidity as a result of inappropriate treatment; and increased drug resistance as a result of incomplete treatment. Recent attention to this issue has led to significant increases in private TB notifications, especially in India, Indonesia and the Philippines, but the gap between notification and the extension of quality program services for provision of treatment and care appears to be growing.
随着各国朝着实现全民健康覆盖迈进，促使所有医疗服务提供者参与其中的努力变得越发重要。据估计，2018年有超过三分之一的结核病患者未被国家结核病规划（NTPs）发现和报告。在私营部门规模较大的国家，尤其是结核病负担较重的国家，这一差距更为明显。国家结核病规划范围之外的医疗服务提供者，包括私营和非正规部门，往往是结核病患者的首诊点。然而，尽管有来自各国经验和项目的证据表明，公私混合（PPM）方法可提高发现率并取得良好治疗效果，但这些提供者并未充分参与进来。虽然人们常常担心公共机构的医疗质量，但也有越来越多的证据表明，许多地方私营部门的结核病医疗质量未达到国际标准，迫切需要改进。未能让所有医疗服务提供者参与结核病防治工作，在获得优质医疗服务方面会产生严重后果，导致因诊断和治疗延误而增加传播；因治疗不当而导致额外的死亡率和发病率；以及因治疗不完整而增加耐药性。最近对这一问题的关注已使私营部门的结核病报告大幅增加，尤其是在印度、印度尼西亚和菲律宾，但报告与为提供治疗和护理而扩大优质项目服务之间的差距似乎正在扩大。
