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结核病控制的全球目标是到2005年发现70%的估计传染性病例并治愈其中的85%。自采用DOTS策略以来,DOTS覆盖地域大幅增加,DOTS策略下的治疗成功率已接近既定目标,2000年为82%。DOTS下的病例发现率虽然有所提高但仍相对较低,2001年为32%。到2005年可能达不到70%的目标。病例发现率低不是由于对全球结核病例数量的过高估计,而是由于各种原因造成结核病例没有被发现或报告的结果,因为全球结核病例数是在多个条件下得到的估计数。这里的各种原因包括人们去结核病机构就诊的渠道不畅,结核病人未被怀疑或正确诊断,结核病例未被报告,以及公共卫生项目或私人医疗机构与国家结核病规程缺乏联系等。自从提出全球结核病控制目标以来,病例发现工作已经取得了一些进展。政府承诺力度增加了,也动员了一些额外的经济资源,增强了抗结核药物的利用途径,还提高了结核病控制的计划和协作力度。但仍然存在一些制约因素,最重要者当属人力资源缺乏。尽管这个难题正在解决中,许多国家苦于缺乏受过训练的卫生保健人员。最后,面对当前的挑战,已经发展了新的策略,例如公立——私立结合项目、社区结核病保健、社会动员、TB/HIV的联合干预措施以及《肺部健康促进实用方法》。为实现上述目标,应当维持并加强当前的努力。
The global goal of tuberculosis control is to detect 70% of estimated infectious cases and 85% of them by 2005. Since the adoption of the DOTS strategy, there has been a substantial increase in DOTS coverage, and the success rate of treatment under the DOTS strategy has approached its target of 82% in 2000. The case-finding rate under DOTS, though still somewhat lower, was 32% in 2001. By 2005 may reach less than 70% of the target. The low case-finding rate is not due to an overestimation of the number of TB cases globally, but rather to the non-detection or reporting of TB cases for a variety of reasons, as the global TB case count is estimated under several conditions. Various causes include poor access to TB facilities, undoubted or correct TB patient diagnosis, non-reporting of tuberculosis cases, and lack of linkages between public health programs or private health facilities and national tuberculosis protocols. Some progress has been made in case finding since the goal of global tuberculosis control was proposed. Government commitment has increased, some additional economic resources have been mobilized, the use of anti-TB drugs has been enhanced, and the control and coordination of tuberculosis programs have also been enhanced. However, there are still some constraints, the most important being the lack of human resources. Although this problem is being solved, many countries suffer from a shortage of trained health-care workers. Finally, in the face of current challenges, new strategies have been developed such as public-private combination projects, community TB care, social mobilization, joint TB / HIV interventions, and “practical approaches to lung health promotion”. In order to achieve the above objectives, the current efforts should be maintained and strengthened.