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COPD 2018: Axshya项目对印度旁遮普邦结核病指标的影响

摘要

背景:Axshya项目是联盟东南亚办事处的一个旗舰项目，采用宣传传播和社会动员战略以及积极的案例调查，以提高印度国家结核控制项目服务在印度300个地区(21个邦)的弱势和边缘人群中的可见度和覆盖面。我们希望评估该项目在2013- 2015年期间对印度旁遮普邦国家结核控制项目下结核病指标的影响。方法:印度北部的旁遮普邦在2013年有15个区，这些区被进一步划分为50个分区行政单位，称为结核病单位(TU)。在这50个项目中，Axshya项目在35个单位内实施。我们收集了2013- 2015年每季度TU水平结核病指标(每lac人群)。评价指标为结核病推定涂片检出率(PTSER)、结核病新涂片阳性病例通报率(NSPTCNR)和各种类型结核病报告率(AFTCNR)。结果:2013-15年TU水平TB指标变化趋势如图所示。在没有Axshya项目的情况下，平均TU水平PTSER为137 / lac人口，而Axshya项目的实施导致PTSER每季度显著增加44 (0.95 CI: 9,78) / lac人口。在没有Axshya项目的情况下，平均TU水平NSPTCNR为14 / lac人口，实施Axshya项目导致每季度NSPTCNR增加1.5 (0.95 CI: - 0.5, 3) / lac人口，但这一增加在统计学上不显著。在没有Axshya项目的情况下，TU平均AFTCNR水平为每lac人口27，而Axshya项目的实施导致AFTCNR每季度显著增加9 (0.95 CI: 3,15)。 Conclusion: Project Axshya had an impact on TB indicators in the state of Punjab, India. Tuberculosis (TB) is the leading cause of death among infectious diseases. In 2016, approximately 10.4 million people developed tuberculosis and 1.7 million died of it. Although tuberculosis diagnosis and treatment services are free of charge under national tuberculosis programs, patients bear significant direct, non-direct and indirect medical costs due to tuberculosis treatment. Cost measurement, especially during the diagnosis of tuberculosis, is important because it is the most uncertain period during the disease and most social protection measures do not cover the costs incurred during the diagnosis. A systematic review reported that the total cost of tuberculosis treatment was equivalent to 39% (range: 4–148%) of annual family income (AHI). Half of the total cost was incurred before TB treatment. The high costs of diagnosing tuberculosis may be due to the way tuberculosis care services are organized. Patients must visit health services alone for diagnosis [passive case research (PCF)], and only after the diagnosis of tuberculosis does the program take active responsibility for taking care of them. The process of reaching healthcare facilities could be time consuming, cumbersome and expensive. Since tuberculosis services are integrated with the general health system, the geographical, financial and social barriers to accessing TB treatment are similar to those for access to the general health system. Patients become trapped in a vicious circle of repeated visits to the same health care provider (HCP) or visits to multiple healthcare professionals, including private and traditional healthcare professionals.  Sukhwinder Singh

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