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首页> 外文期刊>The Lancet Global Health >Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models
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Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models

机译：在南非，中国和印度实现2025年世界卫生组织全球结核病目标的可行性：对11种数学模型的综合分析

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SummaryBackground The post-2015 End {TB} Strategy proposes targets of 50% reduction in tuberculosis incidence and 75% reduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in three high-burden countries with contrasting epidemiology and previous programmatic achievements. Methods 11 independently developed mathematical models of tuberculosis transmission projected the epidemiological impact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, and South Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives from national tuberculosis programmes and the advocacy community provided distinct country-specific intervention scenarios, which included screening for symptoms, active case finding, and preventive therapy. Findings Aggressive scale-up of any single intervention scenario could not achieve the post-2015 End {TB} Strategy targets in any country. However, the models projected that, in the South Africa national tuberculosis programme scenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieve a 55% reduction in incidence (range 31–62%) and a 72% reduction in mortality (range 64–82%) compared with 2015 levels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performance fell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated the high impact of detecting and treating latent tuberculosis. Interpretation Major reductions in tuberculosis burden seem possible with current interventions. However, additional interventions, adapted to country-specific tuberculosis epidemiology and health systems, are needed to reach the post-2015 End {TB} Strategy targets at country level. Funding Bill and Melinda Gates Foundation
机译：摘要背景2015年末{TB}战略提出了到2025年将结核病发病率降低50％和结核病死亡率降低75％的目标。我们的目标是评估这些目标在三个流行病学与先前相反的高负担国家中是否可行计划成就。方法11个独立开发的结核病传播数学模型预测了当前可用的结核病干预措施在中国，印度和南非的流行病学影响，以进行预防，诊断和治疗。使用2012年结核病发病率和死亡率数据对模型进行了校准。来自国家结核病规划和倡导社区的代表提供了针对特定国家/地区的干预方案，包括筛查症状，积极发现病例和进行预防性治疗。调查结果在任何国家，任何一种干预方案的激进扩展都无法实现2015年后{TB}战略的目标。然而，这些模型预测，在南非国家结核病规划方案中，对接受抗逆转录病毒疗法的个人进行连续异烟肼预防性治疗，在卫生中心扩大基于设施的结核病症状筛查以及改善结核病护理的结合可以达到55与2015年的水平相比，发病率降低了31％（62％至62％），死亡率降低了64％至82％（72％）。对于印度，特别是对中国，尽管预防了3,400万例病例，但全面扩大结核病规划效绩的所有干预措施仍未达到2025年的目标。倡导方案说明了检测和治疗潜伏性肺结核的巨大影响。解释目前的干预措施似乎有可能大大减轻结核病负担。但是，需要采取其他适应国别结核病流行病学和卫生系统的干预措施，才能在国家一级实现2015年后{TB}战略的目标。资助法案和梅琳达·盖茨基金会

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