将业务研究作为改善世卫组织欧洲地区耐药结核病治疗成果的机制

G. B. Migliori, O. Korotych, J. Achar, A. Ciobanu, G. Dravniece, M. Germanovych, E. Gurbanova, A. Hovhannesyan, N. Khachatryan, L. Kukša, N. Lomtadze, M.L. Rich, A. Skrahina, A. Yedilbayev
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摘要

2022年,世卫组织欧洲区域的耐利福平/耐多药结核病(RR/MDR-TB)病例占所有发病病例的15.1%。大多数病例发生在东欧和中亚的18个高度优先国家,其中许多国家加入了世卫组织欧洲区域办事处领导的一项倡议。该倡议旨在引入三种全口服、为期 9 个月的改良短程治疗方案(mSTR),在实际研究条件下治疗 RR/MDR-TB 病例。这三种治疗方案是1)贝达喹啉+利奈唑胺+左氧氟沙星+氯法齐明+环丝氨酸(BdqLzdLfxCfzCs);2)BdqLzdLfxCfz+德拉马尼(Dlm),用于6岁以上儿童和成人;3)DlmLzdLfxCfz,用于6岁以下儿童。该项目旨在提高治疗成功率、促进mSTR的实施、提高护理质量和建设研究能力,同时也有助于增进全球对全口服mSTR使用的了解。2020 年 4 月至 2022 年 6 月期间,世卫组织欧洲地区有超过 2800 名患者接受了 mSTR 治疗。这一独特的经验促进了与欧洲内外的国家结核病计划、卫生当局、专家和捐助者的进一步合作,重点是在该地区结核病高负担国家开展业务研究和提高护理质量。为了鼓励其他国家采用这种模式,我们介绍了该倡议的原则、优缺点和下一步措施。
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Operational research as a mechanism to improve treatment outcomes for drug-resistant TB in the WHO European Region
In 2022, the WHO European Region accounted for 15.1% of all incident rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB) cases. Most occurred in 18 high-priority countries of eastern Europe and central Asia, many of which joined an initiative led by the WHO Regional Office for Europe. The aim was to introduce three, fully oral, 9-month modified shorter treatment regimens (mSTR) to treat RR/MDR-TB under operational research conditions. The three regimens were: 1) bedaquiline + linezolid + levofloxacin + clofazimine + cycloserine (BdqLzdLfxCfzCs); 2) BdqLzdLfxCfz + delamanid (Dlm) for children over 6 years of age and adults; and 3) DlmLzdLfxCfz for children under 6 years of age. The project aimed to enhance treatment success, facilitate mSTR implementation, promote quality of care and build research capacity, while also contributing to global knowledge on all-oral mSTR use. Between April 2020 and June 2022, >2,800 patients underwent mSTR treatment in the WHO European Region. This unique experience promoted further collaboration with national tuberculosis programmes, health authorities, experts and donors within and outside Europe, with a focus on implementing operational research and improving the quality of care in high TB burden countries of the region. In the hope of encouraging others to adopt this model, we have described the principles of the initiative, its strengths and weaknesses and next steps.
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