2016-2022年消除结核病进展和结核病计划绩效--国家结核病指标项目。

IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Rachel Woodruff, Robert Pratt, Maureen Kolasa
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引用次数: 0

摘要

问题/条件:消灭结核病(TB)的定义是将美国每年每百万人中的结核病发病率降至 1 例以下。2022 年,美国的结核病发病率为每 10 万人 2.5 例。美国疾病预防控制中心结核病项目制定了一套国家结核病指标,通过监测各州市结核病项目活动的绩效来评估消除结核病的进展情况。通过检查结核病指标数据,州和城市一级的结核病计划能够确定计划评估和改进活动的领域。这些数据还有助于疾病预防控制中心确定可能从技术援助中受益的州和城市:五项指标中每项指标都有最新数据的五年期:1)总体结核病发病率(2018-2022 年);2)非美国出生者的结核病发病率(2018-2022 年);3)报告药物敏感性结果者的百分比(2018-2022 年);4)与新诊断为潜伏肺结核感染(LTBI)的痰酸性ast bacillus(AFB)涂片阳性肺结核患者接触并完成治疗者的百分比(2017-2021 年);5)在 12 个月内完成结核病治疗者的百分比(2016-2020 年):国家结核病指标项目(NTIP)是一个基于网络的绩效监测工具,它使用通过国家结核病监测系统(National TB Surveillance System)和结核病项目评估汇总报告(Aggregate Reports for TB Program Evaluation)报告的国家结核病监测数据。开发 NTIP 的目的是促进现有数据的使用,以帮助结核病项目工作人员确定活动的优先次序、监控进展情况并集中精力改进项目。本报告选择了以下五个指标,因为它们在联邦结核病资金分配和加速结核病病例减少方面具有重要意义:1) 美国结核病的总体发病率;2) 非美国出生者中的结核病发病率;3) 报告药物敏感性结果者的百分比;4) 痰 AFB 涂片阳性结核病病例的接触者中完成长期肺结核治疗者的百分比;5) 在 12 个月内完成结核病治疗者的百分比。在本报告中,52 个结核病防治项目(50 个州、哥伦比亚特区和纽约市)根据向国家结核病监测系统报告的 5 年平均结核病例数被分为三等。通过这种分组方式,可以对结核病例数量相近的结核病计划进行比较,并将数量相近的结核病计划分配到每个类别中。以下公式用于计算各结核病项目在各项指标上的相对变化:[结果:结果:在有最新数据可查的 5 年期间,大多数结核病防治项目在降低总体结核病发病率(71.2%)和提高接触者中被确诊为迟发性肺结核并完成迟发性肺结核治疗者的比例(55.8%)方面都有所改善;大多数项目(51.0%)在降低非美国出生者的发病率方面也有所改善。大多数辖区(52个辖区中的28个,[53.9%])报告的药物敏感性结果的平均百分比达到或超过了5年全国平均水平97%(2018-2022年)。从 2017 年到 2021 年,52 个辖区中有 29 个辖区(55.8%)新诊断为潜伏肺结核感染(LTBI)的痰酸性ast bacillus(AFB)涂片阳性肺结核患者的接触者完成治疗的百分比有所增加,这表明大多数辖区已采取措施提高这方面的绩效。约三分之二的辖区(52 个辖区中的 32 个[61.5%])在 12 个月内完成结核病治疗的患者平均比例达到或超过 89.7% 的全国平均水平:本报告首次描述了肺结核项目绩效的 5 年相对变化。这些结果表明,肺结核项目在帮助识别肺结核和迟发性肺结核患者并确保患者及时完成治疗的活动方面正在取得进展:公共卫生行动:使用来自各个结核病项目的 NTIP 数据可以更详细地检查项目绩效的趋势,并确定项目改进的领域。通过评估结核病项目的指标趋势,可以更好地了解与其他项目相比的项目绩效。它还能促进项目之间就项目改进中的成功与挑战进行交流。这些信息对结核病项目有效分配资源很有价值,并为公共卫生决策者提供了更多有关结核病控制的信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance - National Tuberculosis Indicators Project, 2016-2022.

Problem/condition: Elimination of tuberculosis (TB) is defined as reducing TB disease incidence in the United States to less than 1 case per million persons per year. In 2022, TB incidence in the United States was 2.5 TB cases per 100,000 persons. CDC's TB program developed a set of national TB indicators to evaluate progress toward TB elimination through monitoring performance of state and city TB program activities. Examining TB indicator data enables state- and city-level TB programs to identify areas for program evaluation and improvement activities. These data also help CDC identify states and cities that might benefit from technical assistance.

Period covered: The 5-year period for which the most recent data were available for each of five indicators: 1) overall TB incidence (2018-2022), 2) TB incidence among non-U.S.-born persons (2018-2022), 3) percentage of persons with drug susceptibility results reported (2018-2022), 4) percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment (2017-2021), and 5) percentage of patients with completion of TB therapy within 12 months (2016-2020).

Description of system: The National TB Indicators Project (NTIP) is a web-based performance monitoring tool that uses national TB surveillance data reported through the National TB Surveillance System and the Aggregate Reports for TB Program Evaluation. NTIP was developed to facilitate the use of existing data to help TB program staff members prioritize activities, monitor progress, and focus program improvement efforts. The following five indicators were selected for this report because of their importance in Federal TB funding allocation and in accelerating the decline in TB cases: 1) overall TB incidence in the United States, 2) TB incidence among non-U.S.-born persons, 3) percentage of persons with drug susceptibility results reported, 4) percentage of contacts to sputum AFB smear-positive TB cases who completed treatment for LTBI, and 5) percentage of patients with completion of TB therapy within 12 months. For this report, 52 TB programs (50 states, the District of Columbia, and New York City) were categorized into terciles based on the 5-year average number of TB cases reported to National TB Surveillance System. This grouping allows comparison of TB programs that have similar numbers of TB cases and allocates a similar number of TB programs to each category. The following formula was used to calculate the relative change by TB program for each indicator: [(% from year 5 - % from year 1 ÷ % from year 1) × 100].

Results: During the 5-year period for which the most recent data were available, most TB programs had improvements in reducing overall TB incidence (71.2%) and increasing the percentage of contacts receiving a diagnosis of LTBI who completed LTBI treatment (55.8%); the majority of programs (51.0%) also had improvements in reducing incidence among non-U.S.-born persons. The average percentage of persons with drug susceptibility results reported in most jurisdictions (28 of 52, [53.9%]) met or exceeded the 5-year national average of 97% (2018-2022). The percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment increased in 29 of 52 (55.8%) jurisdictions from 2017 to 2021, signifying that, for most jurisdictions, steps have been taken to enhance performance in this area. The average percentage of patients with completion of TB therapy within 12 months was at or above the national average of 89.7% in approximately two-thirds (32 of 52 [61.5%]) of jurisdictions.

Interpretation: This report is the first to describe a 5-year relative change for TB program performance. These results suggest that TB programs are making improvements in activities that help identify persons with TB and LTBI and ensure patients complete treatment in a timely manner.

Public health action: Use of NTIP data from individual TB programs enables a more detailed examination of trends in program performance and identification of areas for program improvement. Assessing indicator trends by TB program provides an opportunity to gain a better understanding of program performance in comparison to other programs. It can also facilitate communication between programs regarding successes and challenges in program improvement. This information is valuable for TB programs to allocate resources effectively and provide additional context on TB control for public health policymakers.

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来源期刊
Mmwr Surveillance Summaries
Mmwr Surveillance Summaries PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
60.50
自引率
1.20%
发文量
9
期刊介绍: The Morbidity and Mortality Weekly Report (MMWR) Series, produced by the Centers for Disease Control and Prevention (CDC), is commonly referred to as "the voice of CDC." Serving as the primary outlet for timely, reliable, authoritative, accurate, objective, and practical public health information and recommendations, the MMWR is a crucial publication. Its readership primarily includes physicians, nurses, public health practitioners, epidemiologists, scientists, researchers, educators, and laboratorians.
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