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异烟肼预防性治疗(isoniazid preventive therapy,IPT)是结核病防治规划(NTP)和艾滋病防治规划(NAP)联合行动的一项重要内容,目的是降低艾滋病病毒(HIV)感染者的结核病负担。然而,真正实施IPT的国家却很少。由于这一措施实施的失败,近期提出了称作“3个I”的口号(即实施感染控制(Infection control),预防结核病在卫生服务机构内传播;在艾滋病病毒感染者和艾滋病病人中加强结核病患者的发现IntensifiedTB case finding,和IPT。在本文中,我们首先回顾IPT的背景,然后讨论在HIV感染者中开展IPT面临的主要挑战,包括:实施IPT的责任和义务,发现结核分枝杆菌潜伏感染者,排除活动性结核病患者,预防异烟肼耐药,以及治疗时间和有效保护期。同时,我们也对几个目前尚未解决的、还在研究中的问题给予高度重视。最后,我们对现场如何推广IPT提出了可操作性的建议,包括:将IPT整合在艾滋病的一系列治疗关怀服务包中,遵照哲学上“边做边学”的原理开展实施性研究,制定入选IPT的流程图,制定和实施抗病毒治疗前的关怀服务,以及有关采购、供应、监控与评价等问题。我们支持IPT的实施,但前提是在安全和有序组织管理的条件下。如果IPT的实施不够仔细、慎重,则将导致无任何效果,反而使得情况变得更糟,甚至导致耐多药结核病的产生,这是一定要避免的。
Isoniazid preventive therapy (IPT) is an important part of the joint NTP and NAP initiative to reduce the burden of tuberculosis among people living with HIV. However, few countries actually implement IPT. As a result of the failure of this measure to be implemented, a slogan called “3 I” has recently been proposed (that is, the implementation of Infection control to prevent the spread of tuberculosis in health services. In HIV-infected and AIDS patients In this article, we first review the background of IPT and then discuss the key challenges in developing IPT among HIV-infected individuals, including: the responsibility and obligation to implement IPT and the identification of tuberculosis branches Bacilli latent infection, excluding active tuberculosis patients, prevention of isoniazid resistance, as well as the treatment time and effective protection period.At the same time, we also pay attention to several issues that are not yet solved and still under study.Finally, We put forward some feasible suggestions on how to promote IPT on the site, including integrating the IPT into a series of AIDS-related treatment care packages and carrying out implementation studies in accordance with the philosophy of “learning by doing” IPT flow chart, development and implementation of care services prior to antiviral treatment, as well as procurement, supply, monitoring and evaluation issues, etc. We support the implementation of IPT, The premise is that under the condition of safe and orderly organization and management, if IPT implementation is not implemented carefully and carefully, it will lead to no effect and will actually make the situation even worse and even lead to the emergence of MDR-TB, which is bound to be Avoided.