Community-wide Screening for Tuberculosis in a High-Prevalence Setting
Community-wide Screening for Tuberculosis in a High-Prevalence Setting
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DOI：
10.1056/nejmoa1902129
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发表时间：
2019-10-03
影响因子：
158.5
通讯作者：
Fox, Greg J.
中科院分区：
文献类型：
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作者：
Marks, Guy B.;Nguyen, Nhung V.;Fox, Greg J.
背景世界卫生组织为全球消除结核病制定了雄心勃勃的目标。然而，按照目前的进展速度，这些目标将无法实现。方法：我们在越南金瓯省进行了一项随机分组对照试验，以评估与单纯的标准被动病例检测相比，全社区主动筛查在降低结核病患病率方面的有效性。从2014年开始，对居住在60个干预集群（社区）的15岁或以上的人进行肺结核筛查，无论症状如何，每年一次，持续3年，通过对自发痰样本进行快速核酸扩增检测。在最初的3年中，在60个对照组中没有进行主动筛查。第四年测量的主要结果是15岁或以上人群中经微生物学证实的肺结核的患病率。次要结果是2012年出生的儿童在第四年通过干扰素γ释放试验评估的结核病感染患病率。结果在第四年的患病率调查中，我们对干预组的42,150名参与者和对照组的41,680名参与者进行了测试。通过结核分枝杆菌核酸扩增试验阳性证实，干预组共有53名参与者（126/100，000）和对照组共有94名参与者（226/100，000）患有肺结核（患病率为0.56; 95%可信区间[CI]为0.40至0.78; P
Background The World Health Organization has set ambitious targets for the global elimination of tuberculosis. However, these targets will not be achieved at the current rate of progress. Methods We performed a cluster-randomized, controlled trial in Ca Mau Province, Vietnam, to evaluate the effectiveness of active community-wide screening, as compared with standard passive case detection alone, for reducing the prevalence of tuberculosis. Persons 15 years of age or older who resided in 60 intervention clusters (subcommunes) were screened for pulmonary tuberculosis, regardless of symptoms, annually for 3 years, beginning in 2014, by means of rapid nucleic acid amplification testing of spontaneously expectorated sputum samples. Active screening was not performed in the 60 control clusters in the first 3 years. The primary outcome, measured in the fourth year, was the prevalence of microbiologically confirmed pulmonary tuberculosis among persons 15 years of age or older. The secondary outcome was the prevalence of tuberculosis infection, as assessed by an interferon gamma release assay in the fourth year, among children born in 2012. Results In the fourth-year prevalence survey, we tested 42,150 participants in the intervention group and 41,680 participants in the control group. A total of 53 participants in the intervention group (126 per 100,000 population) and 94 participants in the control group (226 per 100,000) had pulmonary tuberculosis, as confirmed by a positive nucleic acid amplification test for Mycobacterium tuberculosis (prevalence ratio, 0.56; 95% confidence interval [CI], 0.40 to 0.78; P