Brewer T F, Heymann S J, Harris J B
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Ann Acad Med Singap. 1997 Sep;26(5):642-6.
Despite the availability of effective treatment, tuberculosis (TB) causes more deaths than any other infection. Most of the world's TB cases and deaths occur in Asia and the Western Pacific, and the growing prevalence of multiple drug-resistant TB and the spread of human immunodeficiency virus (HIV) present ever greater obstacles to effective TB control. The management of TB remains difficult, and epidemiologic studies to assess control programmes require significant time and expense and may not be generalizable to other regions. Computer models are powerful and relatively inexpensive tools for rapidly planning and evaluating TB control strategies. Models have demonstrated the value of targeted chemoprophylaxis strategies for the prevention of TB among HIV-infected individuals, and programmes to ensure that all HIV-infected individuals receive TB chemoprophylaxis should be considered in Asia and the Western Pacific. Though directly observed therapy (DOT) is effective when designed to be attractive to patients, modelling has shown that DOT, if poorly accepted by patients, may lead to fewer patients seeking care and thus to paradoxical rises in TB case rates. Models may be used to make accurate predictions of TB morbidity and programme costs using local epidemiologic and demographic inputs. The use of models in Asia and the Western Pacific offers a low-cost way to compare programmes, to improve the evaluation of programmes, to project future cases, and to examine programme needs while providing insights into TB control helpful to countries in and out of the region.
尽管有有效的治疗方法，但结核病导致的死亡人数仍超过其他任何一种感染性疾病。世界上大多数结核病病例和死亡发生在亚洲及西太平洋地区，多重耐药结核病的患病率不断上升以及人类免疫缺陷病毒（HIV）的传播给有效的结核病控制带来了越来越大的障碍。结核病的管理仍然困难，评估控制项目的流行病学研究需要大量时间和费用，而且可能无法推广到其他地区。计算机模型是用于快速规划和评估结核病控制策略的强大且相对廉价的工具。模型已经证明了针对性化学预防策略在预防HIV感染者结核病方面的价值，在亚洲和西太平洋地区应考虑实施确保所有HIV感染者接受结核病化学预防的项目。虽然直接观察治疗（DOT）在设计上对患者有吸引力时是有效的，但模型显示，如果患者接受度低，DOT可能会导致寻求治疗的患者减少，从而导致结核病发病率出现反常上升。利用当地的流行病学和人口统计学数据输入，模型可用于准确预测结核病发病率和项目成本。在亚洲和西太平洋地区使用模型提供了一种低成本的方式来比较项目、改进项目评估、预测未来病例以及检查项目需求，同时为该地区内外的国家提供有助于结核病控制的见解。
