TB Unit, National Infection Service, Public Health England, London, UK.
TB Unit, National Infection Service, Public Health England, London, UK.
Lancet Infect Dis. 2021 Sep;21(9):e272-e280. doi: 10.1016/S1473-3099(21)00077-3.
Meeting the 2035 WHO targets of reducing tuberculosis incidence by 90% from 2015 levels requires the implementation of country-specific tuberculosis control strategies. This systematic review aims to identify factors that facilitate or impede the implementation of such strategies in EU and European Economic Area (EEA) settings. Focusing on providers of care, health system constraints, and social and political factors, this Review complements available evidence on the accessibility of tuberculosis services to recipients of care. Databases were searched for EU and EEA articles published between Jan 1, 1997, and Nov 6, 2020, that presented empirical data on tuberculosis policies, strategies, guidelines, or interventions. 2061 articles were screened and 65 were included. The most common barrier to tuberculosis control strategies described the divergence of health-care practices from guidelines, often related to inadequate knowledge or perceived usefulness of the guidelines by clinicians. The most commonly identified enabler to tuberculosis control strategies was the documented positive attitudes of health-care workers towards tuberculosis programmes. Divergence between clinical practice and guidelines was described in most EU and EEA settings, indicating the need for a focused review of guideline adherence. Strengths of this study involve its broad inclusion criteria and wide range of tuberculosis control strategies analysed.
实现世界卫生组织（WHO）到 2035 年将结核病发病率在 2015 年水平上降低 90%的目标，需要实施针对具体国家的结核病控制策略。本系统评价旨在确定在欧盟和欧洲经济区（EEA）环境中有利于或阻碍此类策略实施的因素。本研究重点关注卫生保健提供者、卫生系统限制以及社会和政治因素，补充了关于结核病服务对卫生保健接受者可及性的现有证据。在 1997 年 1 月 1 日至 2020 年 11 月 6 日期间，检索了欧盟和欧洲经济区发表的文章数据库，这些文章提供了关于结核病政策、战略、指南或干预措施的实证数据。共筛选了 2061 篇文章，纳入了 65 篇。描述结核病控制策略的最常见障碍是卫生保健实践与指南之间的分歧，这通常与临床医生对指南的知识不足或认为指南没有用有关。结核病控制策略的最常见促进因素是卫生保健工作者对结核病规划的积极态度。在大多数欧盟和欧洲经济区国家/地区都描述了临床实践与指南之间的分歧，这表明需要对指南的遵守情况进行集中审查。本研究的优势在于其广泛的纳入标准和分析的广泛的结核病控制策略。
