TB-and-DOTS肺結(jié)核與點共46張課件

TBandDOTS肺結(jié)核與點31、別人笑我太瘋癲，我笑他人看不穿。(名言網(wǎng))32、我不想聽失意者的哭泣，抱怨者的牢騷，這是羊群中的瘟疫，我不能被它傳染。我要盡量避免絕望，辛勤耕耘，忍受苦楚。我一試再試，爭取每天的成功，避免以失敗收常在別人停滯不前時，我繼續(xù)拼搏。33、如果懼怕前面跌宕的山巖，生命就永遠(yuǎn)只能是死水一潭。34、當(dāng)你眼淚忍不住要流出來的時候，睜大眼睛，千萬別眨眼!你會看到世界由清晰變模糊的全過程，心會在你淚水落下的那一刻變得清澈明晰。鹽。注定要融化的，也許是用眼淚的方式。35、不要以為自己成功一次就可以了，也不要以為過去的光榮可以被永遠(yuǎn)肯定。TBandDOTS肺結(jié)核與點TBandDOTS肺結(jié)核與點31、別人笑我太瘋癲，我笑他人看不穿。(名言網(wǎng))32、我不想聽失意者的哭泣，抱怨者的牢騷，這是羊群中的瘟疫，我不能被它傳染。我要盡量避免絕望，辛勤耕耘，忍受苦楚。我一試再試，爭取每天的成功，避免以失敗收常在別人停滯不前時，我繼續(xù)拼搏。33、如果懼怕前面跌宕的山巖，生命就永遠(yuǎn)只能是死水一潭。34、當(dāng)你眼淚忍不住要流出來的時候，睜大眼睛，千萬別眨眼!你會看到世界由清晰變模糊的全過程，心會在你淚水落下的那一刻變得清澈明晰。鹽。注定要融化的，也許是用眼淚的方式。35、不要以為自己成功一次就可以了，也不要以為過去的光榮可以被永遠(yuǎn)肯定。TB:AGlobalEmergency1/3oftheworld(2billionpeople)infected1personinfected/secondresultingin>30millionnewinfections,8millionnewcasesLeftuntreated1/3die,1/3self-cure,1/3remaininfectiousTBkills1personevery10seconds=5000/day=2-3millioneachyear22HighBurdenCountriesIndiaChinaIndonesiaBangladeshPakistanNigeriaPhilippinesSouthAfricaEthiopiaVietnamRussianFederationCongoBrazilTanzaniaKenyaThailandMyanmarAfghanistanUgandaPeruZimbabweCambodiaTBandDOTS肺結(jié)核與點31、別人笑我太瘋癲，我笑他1TB-and-DOTS肺結(jié)核與點共46張課件2TB-and-DOTS肺結(jié)核與點共46張課件3TB-and-DOTS肺結(jié)核與點共46張課件4TB-and-DOTS肺結(jié)核與點共46張課件5WhendoesTBinfection

becomedisease?MostlikelytooccurinfirsttwoyearsafterinfectionIfpersonbecomesimmunocompromisedHIVCancerChemotherapyPoorlycontrolleddiabetesmalnutritionWhendoesTBinfection

become6The5EssentialComponentsoftheDOTSStrategy

GovernmentcommitmenttoaNationalTBProgramPrioritytodetectinfectiouscasesbysputumsmearmicroscopyStandardizedregimensofshort-coursechemotherapy,givenunderdirectobservationfor,atleast,theintensivephaseRegular,uninterruptedsupplyofanti-TBmedsMonitoringsystemforprogramsupervisionandevaluationThe5EssentialComponentsof71.Political/AdministrativeCommitmentPerceptionofTBasapriorityproblemwithrealsolutionGovernmentacknowledgesimportanceofdiseasePubliccommitmenttoNationalTBProgram(NTP)Supportforpersonnel,training,transportation,drugs1.Political/AdministrativeCo82.AccurateDiagnosis=SputumMicroscopyIdentification/cureofinfectiouscases(smear+)ishighestpriorityofTBcontrolSmear+s4-20timesmoreinfectious;mayinfect10-15/year;morelikelytodieifuntreatedTimelyresultstoreducepotentialfortransmissionQualityassurance/training--nationalreferencelabiskey2.AccurateDiagnosis=SputumM9DiagnosisofpulmonaryTBCough3weeksAFBX3Broad-spectrumantibiotic10-14daysIfsymptomspersist,repeatAFBsmears,X-rayIfconsistentwithTBAnti-TBTreatmentIf1positive,X-rayandevaluation

If2/3positive:Anti-TBRxIf

negative:DiagnosisofpulmonaryTBCough10ChestX-ray(CXR)asDiagnosticToolNoCXRpatternistypicalManyTBcasesaremissed(10-15%culture+s)Manynon-TBcasesmisdiagnosed(40%diagnosedbyCXRalonedonothaveactiveTBPreviousMDtrainingemphasizedCXRasbestdiagnostictoolOftenreactiontopoor,inaccurate,orunavailablelabservicesChestX-ray(CXR)asDiagnosti11X-ray-basedevaluationcausesover-diagnosisofTBNTI,IndJTuberc,1974Over-diagnosisX-ray-basedevaluationcauses12MicroscopyisamorespecifictestthanX-rayforTBdiagnosisSpecificityMicroscopyisamorespecific133.AdequateSupplyofDrugsTreatmentrequiresregulardosesofcombinationregimensfor>6monthsIdentificationofanadequatesupplyofappropriatedrugsforpatientspriortoinitiationoftreatmentessentialIfregimensincomplete,realchanceofdevelopmentofdrug-resistantstrainswhicharehardorimpossibletocureRequirescontinuumofdrugmanagementservices:selection,

procurement,distribution,use.3.AdequateSupplyofDrugsTre144.DirectlyObservedTreatmentWhy?Manypatientsdon’ttakemedicinesregularly,evenifexcellenthealtheducationprovidedWho?Allpatients...impossibletopredictwhichpatientwilltakemedicine(1/3notadherent)What?ObserverwatchesandhelpspatientswallowtabletsWhere?Anywhere!(home,clinic,work,school,etc)Whodoesit?HCW,communityliaisons,teachers,Directobservationensurestreatmentforentirecoursewiththerightdrugs,intherightdoses,attherightintervals4.DirectlyObservedTreatment15DOTisnecessaryevenwhendrugsupplyensured

ChaulkCP.JAMA1998;279:943-8TreatmentSuccessDOTNoDOTDOTisnecessaryevenwhenChau16DOTprolongssurvivalofHIV-infectedTBpatients

SCCwithDOTSCCwithoutDOTDOTprolongssurvivalofSCCwi175.SystematicMonitoring/AccountabilityRecordingsystemissimpletouse,essential,integratedcomponentofDOTSenablingMonitoringofpatientoutcomesEvaluationofprogramperformanceAnalysisofepidemiologicdataIdentificationofareasforOREverylevelofhealthsystemaccountableforpatientdiagnosisandcure;“reportcard”TBRegister5.SystematicMonitoring/Accou18TBandHIV/AIDSHIVnegativelyimpactsTBandTBnegativelyimpactsHIVHIV+individualsinfectedwithTBare30xmorelikelytodevelopTBdiseaseTBisleadingcauseofdeathamongHIV+,accountingfor~40%ofAIDSdeathsHIVincreasestheprevalenceofactiveTBinHIV-andHIV+populationsTBandHIV/AIDSHIVnegatively19Multidrug-ResistantTB(MDRTB)DefinedasresistancetoINHandRIFCausedbyinconsistentorpartialtreatmentofsusceptibleTB(primary)Curerates<70%causetheepidemicanddrugresistancetoincreaseDrugsaremoretoxicandexpensive,andlesseffective;treatmentmoredifficult/expensive,andmorelikelyfatalindevelopingworldPoorlysupervised,incompletetreatmentisworsethannotreatmentatall:PreventionofMDRTBistheprimarystrategytoaddressMDRTBMultidrug-ResistantTB(MDRTB)20USAIDTBStrategySupportfortheSTOPTBInitiativeEstablishmentoffieldsites/programstoserveasmodelsforinnovativewide-scaleTBcontrolInvestigation/implementationofpotentialtechnologiesandmethodologiesforTBprophylaxis,diagnosis,andtreatmentSupportforsurveillancetomonitorTBtrendsandidentifyMDRTB

strainsbeforetheybecomewidespreadUSAIDTBStrategySupportfort21USAIDExpandedResponseContinuedinvestmentsinglobalandregionalpartnerships:supportfortheStopTBinitiativecontinuedworkwithotherUSGagenciesGlobalpartnershiptodevelopnewanti-TBdrugsGlobalDrugFacilityNewInternationalcoalitionoforganizationsandagenciesincludingKNCV,IUATLD,WHO,CDC,ALA/ATStoprovideTA/developTBexpertiseContinuedsupportforcoordinatedresearchtooptimizediagnosticsandtreatmentregimensUSAIDExpandedResponseContinu22USAIDExpandedResponseExpandedresearchinvestmentsrapidandsensitiveTBdiagnostictestsincreasefunding,workwithourpartnerstomobilizeeffortsandexpertiseofPHworkers,industry,academicresearchers,donors,otherpartnersinlab/ORcomponentsTargetcollaborativeeffortstodevelopcost-effectiveTBdrugsandcombinationtherapiesPotentialexpansiontovaccinedevelopmentUSAIDExpandedResponseExpande23USAIDExpandedResponseFocused,expandedprogramsinkeycountries,targetingcountriesofgreatestneed,definedbyTBburdencountrieswithhighHIV/AIDSprevalencecountriesatriskofescalatingMDRepidemicsUSAIDExpandedResponseFocused24TB-and-DOTS肺結(jié)核與點共46張課件25Partners/ImplementersCurrentWHO,CDC,Fogarty/NIH,IUATLD,GorgasInstitute,MSH/RPM,PATH,QAP,FHITBCTA(TBCoalitionforTechnicalAssistance)PotentialNGOs(MSF,DOW,MERLIN)Foundations,WorldBank,USModelCentersPartners/ImplementersCurrent26GlobalPrograms/MechanismsGlobal/BureauumbrellaagreementswithWHOandCDCMultipleagreementstoaddresstechnicalareas:RPM,PATH,TBCTANewinteragencyalliancesunderdevelopmentfordrugprocurement/management/developmentStandardindicatorsalreadydevelopedGlobalPrograms/MechanismsGlob27CommonHealthAssumptionsnotapplicabletoTBAccessisnecessarybutNOTsufficientDrugsServicesNoteveryhealthcenter/NGOsiteappropriateasTBcarecenterPoorprogramisworsethannoprogramatallCommonHealthAssumptionsnot28PrioritiesofTBControlMakesurethepersoncompletesTBtreatment!Donotcausedrugresistance;apoorTBprogramisworsethannoTBprogram!Treatingnon-pulmonarycasesandthoseinfectedwithoutactivediseaseareoflesserpublichealthimportancePrioritiesofTBControlMakes29WithTB,treatmentismorethantreatment,treatmentispreventionWithTB,treatmentismoretha30RoleofRifampicinNecessaryforshort-coursetreatmentEssentialforatleastfirst2monthsofregimensBactericidalforrapidlydividingandslow-growingorganismsPreventsemergenceofresistancetootherdrugsIntermittenttreatmentmoreeffectivethandailytreatmentinanimalmodel;equallyeffectiveinclinicaltrialsRoleofRifampicinNecessaryfo31RoleofIsoniazidMainstayofanti-TBtreatmentLifesavinginTBmeningitisBactericidalforrapidlydividingorganismsPreventsemergenceofresistancetootherdrugsIntermittenttreatmentmoreeffectivethandailytreatmentinanimalmodel;equallyeffectiveinclinicaltrialsSafeandeffectiveforpreventivetreatmentRoleofIsoniazidMainstayofa32DOTScanreducetheTBburdenAnnualpercentagedeclineinincidence/prevalenceDOTScanreducetheTBburdenA33TB:theleadingsingleinfectiouscauseofdeathinSEAsiaNumberofdeaths(1000s)DeathsfrominfectiousagentsinSouth-EastAsia34TB:theleadingsingleinfectiTBisaLeadingKillerofWomenDeathsamongwomenTBisaLeadingKillerofWome35DiagnosisofpulmonaryTB

PatientswithTBfeelillandseekcarepromptlyActivecasefindingisunnecessaryandunproductiveMicroscopyisappropriatetechnology,indicatinginfectiousness,riskofdeath,andpriorityfortreatmentX-rayisnon-specificforTBdiagnosisSerologicalandamplificationtechnologies(PCR,etc.)currentlyofnoprovenvalueinTBcontrolDiagnosisofpulmonaryTBPati36ProportionofpulmonaryTBpatientswithpositiveAFBsmears

010203040506070HIVNegativeEarlyHIVLateHIVAFBpositivityinTBpatientsProportionofpulmonaryTBpat37PrompttreatmentofinfectiouscasesreducesspreadofTBSmear-positivepatientsusuallyseekcareSmear-positivepatientsare4-20timesmoreinfectiousUntreated,asmear-positivepatientmayinfect10-15persons/yearSmear-positivepatientsaremuchmorelikelytodieifuntreatedRouillonA.Tubercle1976;57:275-99Prompttreatmentofinfectious38Severeandlesssevereformsofextra-pulmonaryTBSevereMeningitisLessSevereLymphnodesMiliaryPericarditisBone(excludingspine)BilateralorextensivepleuraleffusionSpinalIntestinalTB/HIV,AClinicalManual,WorldHealthOrganization1996Pleuraleffusion(unilateral)PeripheraljointSevereandlesssevereformso39RoleofPyrazinamideEssentialfor6-and8-monthregimensNobenefitifgiven>2monthsRelativelyineffectiveatpreventingemergenceofresistancetootherdrugsRoleofPyrazinamideEssential40Pyrazinamideessentialforfirsttwomonthsof6/8-monthtreatmentAmRevRespirDis1987;136:1339-42RelapsesPyrazinamideessentialforfir41RoleofEthambutol/StreptomycinPreventemergenceofresistancetootherdrugsgivenHastensputumconversionBacteriostaticorweaklybactericidalagainstrapidlydividingorganismsRoleofEthambutol/Streptomyc42RelapserateslowwithdirectlyobservedtreatmentinbothHIV(+)andHIV(-)patientsAmJRespirCritCareMed1996:154:1034-38RelapseratesRelapse(%)Relapserateslowwithdirectl43Adversereactionstoanti-TBdrugsIsoniazidl

Peripheralneuropathyl

HepatitisDrugsAdversereactionsPyrazinamidel

Jointpainsl

HepatitisRifampicinl

Gastroentestinal(anorexia,nausea,vomiting,abdominalpain)l

Hepatitisl

ReducedeffectivenessoforalcontraceptivepillEthambutoll

OpticneuritisStreptomycinl

Auditory&vestibularnervedamage(alsotofoetus)l

RenaldamageAdversereactionstoanti-TBd44ManagementofDrugLogisticsManagementofStocksCHOICEUSEPURCHASEDISTRIBUTIONSTORAGEQuantificationFinancingTenderbidsOrderQualityControlRe-packagingTransportationInformationforuser&forconsumerAdequatebufferstocksmustbemaintainedatnational,state/regional,andlocallevelsManagementofDrugLogisticsMa45謝謝！21、要知道對好事的稱頌過于夸大，也會招來人們的反感輕蔑和嫉妒?！喔?/p>

22、業(yè)精于勤，荒于嬉；行成于思，毀于隨?！n愈

23、一切節(jié)省，歸根到底都?xì)w結(jié)為時間的節(jié)省?！R克思

24、意志命運往往背道而馳，決心到最后會全部推倒?！勘葋?/p>

25、學(xué)習(xí)是勞動，是充滿思想的勞動?！獮跎晁够淅祟j藍(lán)辣襖駒靴鋸瀾互慌仲寫繹衰斡染圾明將呆則孰盆瘸砒腥悉漠塹脊髓灰質(zhì)炎(講課2019)脊髓灰質(zhì)炎(講課2019)謝謝！21、要知道對好事的稱頌過于夸大，也會招來人們的反感輕46TBandDOTS肺結(jié)核與點31、別人笑我太瘋癲，我笑他人看不穿。(名言網(wǎng))32、我不想聽失意者的哭泣，抱怨者的牢騷，這是羊群中的瘟疫，我不能被它傳染。我要盡量避免絕望，辛勤耕耘，忍受苦楚。我一試再試，爭取每天的成功，避免以失敗收常在別人停滯不前時，我繼續(xù)拼搏。33、如果懼怕前面跌宕的山巖，生命就永遠(yuǎn)只能是死水一潭。34、當(dāng)你眼淚忍不住要流出來的時候，睜大眼睛，千萬別眨眼!你會看到世界由清晰變模糊的全過程，心會在你淚水落下的那一刻變得清澈明晰。鹽。注定要融化的，也許是用眼淚的方式。35、不要以為自己成功一次就可以了，也不要以為過去的光榮可以被永遠(yuǎn)肯定。TBandDOTS肺結(jié)核與點TBandDOTS肺結(jié)核與點31、別人笑我太瘋癲，我笑他人看不穿。(名言網(wǎng))32、我不想聽失意者的哭泣，抱怨者的牢騷，這是羊群中的瘟疫，我不能被它傳染。我要盡量避免絕望，辛勤耕耘，忍受苦楚。我一試再試，爭取每天的成功，避免以失敗收常在別人停滯不前時，我繼續(xù)拼搏。33、如果懼怕前面跌宕的山巖，生命就永遠(yuǎn)只能是死水一潭。34、當(dāng)你眼淚忍不住要流出來的時候，睜大眼睛，千萬別眨眼!你會看到世界由清晰變模糊的全過程，心會在你淚水落下的那一刻變得清澈明晰。鹽。注定要融化的，也許是用眼淚的方式。35、不要以為自己成功一次就可以了，也不要以為過去的光榮可以被永遠(yuǎn)肯定。TB:AGlobalEmergency1/3oftheworld(2billionpeople)infected1personinfected/secondresultingin>30millionnewinfections,8millionnewcasesLeftuntreated1/3die,1/3self-cure,1/3remaininfectiousTBkills1personevery10seconds=5000/day=2-3millioneachyear22HighBurdenCountriesIndiaChinaIndonesiaBangladeshPakistanNigeriaPhilippinesSouthAfricaEthiopiaVietnamRussianFederationCongoBrazilTanzaniaKenyaThailandMyanmarAfghanistanUgandaPeruZimbabweCambodiaTBandDOTS肺結(jié)核與點31、別人笑我太瘋癲，我笑他47TB-and-DOTS肺結(jié)核與點共46張課件48TB-and-DOTS肺結(jié)核與點共46張課件49TB-and-DOTS肺結(jié)核與點共46張課件50TB-and-DOTS肺結(jié)核與點共46張課件51WhendoesTBinfection

becomedisease?MostlikelytooccurinfirsttwoyearsafterinfectionIfpersonbecomesimmunocompromisedHIVCancerChemotherapyPoorlycontrolleddiabetesmalnutritionWhendoesTBinfection

become52The5EssentialComponentsoftheDOTSStrategy

GovernmentcommitmenttoaNationalTBProgramPrioritytodetectinfectiouscasesbysputumsmearmicroscopyStandardizedregimensofshort-coursechemotherapy,givenunderdirectobservationfor,atleast,theintensivephaseRegular,uninterruptedsupplyofanti-TBmedsMonitoringsystemforprogramsupervisionandevaluationThe5EssentialComponentsof531.Political/AdministrativeCommitmentPerceptionofTBasapriorityproblemwithrealsolutionGovernmentacknowledgesimportanceofdiseasePubliccommitmenttoNationalTBProgram(NTP)Supportforpersonnel,training,transportation,drugs1.Political/AdministrativeCo542.AccurateDiagnosis=SputumMicroscopyIdentification/cureofinfectiouscases(smear+)ishighestpriorityofTBcontrolSmear+s4-20timesmoreinfectious;mayinfect10-15/year;morelikelytodieifuntreatedTimelyresultstoreducepotentialfortransmissionQualityassurance/training--nationalreferencelabiskey2.AccurateDiagnosis=SputumM55DiagnosisofpulmonaryTBCough3weeksAFBX3Broad-spectrumantibiotic10-14daysIfsymptomspersist,repeatAFBsmears,X-rayIfconsistentwithTBAnti-TBTreatmentIf1positive,X-rayandevaluation

If2/3positive:Anti-TBRxIf

negative:DiagnosisofpulmonaryTBCough56ChestX-ray(CXR)asDiagnosticToolNoCXRpatternistypicalManyTBcasesaremissed(10-15%culture+s)Manynon-TBcasesmisdiagnosed(40%diagnosedbyCXRalonedonothaveactiveTBPreviousMDtrainingemphasizedCXRasbestdiagnostictoolOftenreactiontopoor,inaccurate,orunavailablelabservicesChestX-ray(CXR)asDiagnosti57X-ray-basedevaluationcausesover-diagnosisofTBNTI,IndJTuberc,1974Over-diagnosisX-ray-basedevaluationcauses58MicroscopyisamorespecifictestthanX-rayforTBdiagnosisSpecificityMicroscopyisamorespecific593.AdequateSupplyofDrugsTreatmentrequiresregulardosesofcombinationregimensfor>6monthsIdentificationofanadequatesupplyofappropriatedrugsforpatientspriortoinitiationoftreatmentessentialIfregimensincomplete,realchanceofdevelopmentofdrug-resistantstrainswhicharehardorimpossibletocureRequirescontinuumofdrugmanagementservices:selection,

procurement,distribution,use.3.AdequateSupplyofDrugsTre604.DirectlyObservedTreatmentWhy?Manypatientsdon’ttakemedicinesregularly,evenifexcellenthealtheducationprovidedWho?Allpatients...impossibletopredictwhichpatientwilltakemedicine(1/3notadherent)What?ObserverwatchesandhelpspatientswallowtabletsWhere?Anywhere!(home,clinic,work,school,etc)Whodoesit?HCW,communityliaisons,teachers,Directobservationensurestreatmentforentirecoursewiththerightdrugs,intherightdoses,attherightintervals4.DirectlyObservedTreatment61DOTisnecessaryevenwhendrugsupplyensured

ChaulkCP.JAMA1998;279:943-8TreatmentSuccessDOTNoDOTDOTisnecessaryevenwhenChau62DOTprolongssurvivalofHIV-infectedTBpatients

SCCwithDOTSCCwithoutDOTDOTprolongssurvivalofSCCwi635.SystematicMonitoring/AccountabilityRecordingsystemissimpletouse,essential,integratedcomponentofDOTSenablingMonitoringofpatientoutcomesEvaluationofprogramperformanceAnalysisofepidemiologicdataIdentificationofareasforOREverylevelofhealthsystemaccountableforpatientdiagnosisandcure;“reportcard”TBRegister5.SystematicMonitoring/Accou64TBandHIV/AIDSHIVnegativelyimpactsTBandTBnegativelyimpactsHIVHIV+individualsinfectedwithTBare30xmorelikelytodevelopTBdiseaseTBisleadingcauseofdeathamongHIV+,accountingfor~40%ofAIDSdeathsHIVincreasestheprevalenceofactiveTBinHIV-andHIV+populationsTBandHIV/AIDSHIVnegatively65Multidrug-ResistantTB(MDRTB)DefinedasresistancetoINHandRIFCausedbyinconsistentorpartialtreatmentofsusceptibleTB(primary)Curerates<70%causetheepidemicanddrugresistancetoincreaseDrugsaremoretoxicandexpensive,andlesseffective;treatmentmoredifficult/expensive,andmorelikelyfatalindevelopingworldPoorlysupervised,incompletetreatmentisworsethannotreatmentatall:PreventionofMDRTBistheprimarystrategytoaddressMDRTBMultidrug-ResistantTB(MDRTB)66USAIDTBStrategySupportfortheSTOPTBInitiativeEstablishmentoffieldsites/programstoserveasmodelsforinnovativewide-scaleTBcontrolInvestigation/implementationofpotentialtechnologiesandmethodologiesforTBprophylaxis,diagnosis,andtreatmentSupportforsurveillancetomonitorTBtrendsandidentifyMDRTB

strainsbeforetheybecomewidespreadUSAIDTBStrategySupportfort67USAIDExpandedResponseContinuedinvestmentsinglobalandregionalpartnerships:supportfortheStopTBinitiativecontinuedworkwithotherUSGagenciesGlobalpartnershiptodevelopnewanti-TBdrugsGlobalDrugFacilityNewInternationalcoalitionoforganizationsandagenciesincludingKNCV,IUATLD,WHO,CDC,ALA/ATStoprovideTA/developTBexpertiseContinuedsupportforcoordinatedresearchtooptimizediagnosticsandtreatmentregimensUSAIDExpandedResponseContinu68USAIDExpandedResponseExpandedresearchinvestmentsrapidandsensitiveTBdiagnostictestsincreasefunding,workwithourpartnerstomobilizeeffortsandexpertiseofPHworkers,industry,academicresearchers,donors,otherpartnersinlab/ORcomponentsTargetcollaborativeeffortstodevelopcost-effectiveTBdrugsandcombinationtherapiesPotentialexpansiontovaccinedevelopmentUSAIDExpandedResponseExpande69USAIDExpandedResponseFocused,expandedprogramsinkeycountries,targetingcountriesofgreatestneed,definedbyTBburdencountrieswithhighHIV/AIDSprevalencecountriesatriskofescalatingMDRepidemicsUSAIDExpandedResponseFocused70TB-and-DOTS肺結(jié)核與點共46張課件71Partners/ImplementersCurrentWHO,CDC,Fogarty/NIH,IUATLD,GorgasInstitute,MSH/RPM,PATH,QAP,FHITBCTA(TBCoalitionforTechnicalAssistance)PotentialNGOs(MSF,DOW,MERLIN)Foundations,WorldBank,USModelCentersPartners/ImplementersCurrent72GlobalPrograms/MechanismsGlobal/BureauumbrellaagreementswithWHOandCDCMultipleagreementstoaddresstechnicalareas:RPM,PATH,TBCTANewinteragencyalliancesunderdevelopmentfordrugprocurement/management/developmentStandardindicatorsalreadydevelopedGlobalPrograms/MechanismsGlob73CommonHealthAssumptionsnotapplicabletoTBAccessisnecessarybutNOTsufficientDrugsServicesNoteveryhealthcenter/NGOsiteappropriateasTBcarecenterPoorprogramisworsethannoprogramatallCommonHealthAssumptionsnot74PrioritiesofTBControlMakesurethepersoncompletesTBtreatment!Donotcausedrugresistance;apoorTBprogramisworsethannoTBprogram!Treatingnon-pulmonarycasesandthoseinfectedwithoutactivediseaseareoflesserpublichealthimportancePrioritiesofTBControlMakes75WithTB,treatmentismorethantreatment,treatmentispreventionWithTB,treatmentismoretha76RoleofRifampicinNecessaryforshort-coursetreatmentEssentialforatleastfirst2monthsofregimensBactericidalforrapidlydividingandslow-growingorganismsPreventsemergenceofresistancetootherdrugsIntermittenttreatmentmoreeffectivethandailytreatmentinanimalmodel;equallyeffectiveinclinicaltrialsRoleofRifampicinNecessaryfo77RoleofIsoniazidMainstayofanti-TBtreatmentLifesavinginTBmeningitisBactericidalforrapidlydividingorganismsPreventsemergenceofresistancetootherdrugsIntermittenttreatmentmoreeffectivethandailytreatmentinanimalmodel;equallyeffectiveinclinicaltrialsSafeandeffectiveforpreventivetreatmentRoleofIsoniazidMainstayofa78DOTScanreducetheTBburdenAnnualpercentagedeclineinincidence/prevalenceDOTScanreducetheTBburdenA79TB:theleadingsingleinfectiouscauseofdeathinSEAsiaNumberofdeaths(1000s)DeathsfrominfectiousagentsinSouth-EastAsia80TB:theleadingsingleinfectiTBisaLeadingKillerofWomenDeathsamongwomenTBisaLeadingKillerofWome81DiagnosisofpulmonaryTB

PatientswithTBfeelillandseekcarepromptlyActivecasefindingisunnecessaryandunproductiveMicroscopyisappropriatetechnology,indicatinginfectiousness,riskofdeath,andpriorityfortreatmentX-rayisnon-specificforTBdiagnosisSerologicalandamplificationtechnologies(PCR,etc.)currentlyofnoprovenvalueinTBcontrolDiagnosisofpulmonaryTBPati82ProportionofpulmonaryTBpatientswithpositiveAFBsmears

010203040506070HIVNegativeEarlyHIVLateHIVAFBp