Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial.
Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial.
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DOI：
10.1016/s0140-6736(10)61425-0
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发表时间：
2010-10-09
期刊：
影响因子：
168.9
通讯作者：
Hayes, Richard J.
中科院分区：
文献类型：
--
作者：
Corbett, Elizabeth L.;Bandason, Tsitsi;Duong, Trinh;Dauya, Ethel;Makamure, Beauty;Churchyard, Gavin J.;Williams, Brian G.;Munyati, Shungu S.;Butterworth, Anthony E.;Mason, Peter R.;Mungofa, Stanley;Hayes, Richard J.
在艾滋病毒高流行环境中控制结核病是一项紧迫的公共卫生优先事项。我们测试了两种主动病例发现策略，以诊断前的长时间传染性为目标，这是艾滋病毒阴性结核病的典型特征，也是传播的关键驱动因素。对津巴布韦哈拉雷高密度住宅区的社区群进行随机分组，每隔6个月通过流动面包车或挨家挨户访问接受6轮积极病例发现。随机化是通过从一个不透明的袋子中选择两种颜色的圆盘来完成的，其中一个圆盘代表每个簇，在选择开始之前，每个干预组分配一种颜色。在两组中，自愿慢性咳嗽（≥2周）的成人（≥16岁）居民采集两份痰标本进行荧光显微镜检查。社区卫生工作者和群集居民不参与干预分配，但调查人员和实验室工作人员在最终分析之前不参与分配。主要结局是干预组之间每1000名成年居民痰阳性结核病的累积发病率的比较；分析的目的是治疗。次要结局是从两个干预组中随机选择的12%的家庭中，从干预前到干预第6轮之前培养阳性结核病患病率的变化；分析是基于在两次患病率调查中提供痰的参与者。该试验已注册，编号为ISRCTN84352452。确定了46个研究小组，并在干预组之间随机分配，在基线时，移动面包车组有55 741名成年人，门到门组有54 691名成年人。艾滋病毒感染率为21%(1916/9060)，在干预前6个月，涂片阳性病例通报率为每年每1000名成年人2.8例。试验按计划完成，无不良事件发生。移动面包车在5466名提交痰液的参与者中检测到255名涂片阳性患者，而通过上门访问确定的4711名参与者中检测到137名（调整风险比为1.48,95% CI为1.11 - 1.96,p= 0.0087）。结核培养阳性的总体患病率从每1000名成人6.5例（95% CI为5.1 - 8.3）下降到每1000名成人3.7例（95% CI为5.6 - 5.0）；调整后风险比为0.59,95% CI为0.40 - 0.89,p= 0.0112)。广泛实施主动病例发现，特别是采用流动货车方法，可对结核病的传播和疾病产生迅速影响。威康信托基金会。
Control of tuberculosis in settings with high HIV prevalence is a pressing public health priority. We tested two active case-finding strategies to target long periods of infectiousness before diagnosis, which is typical of HIV-negative tuberculosis and is a key driver of transmission. Clusters of neighbourhoods in the high-density residential suburbs of Harare, Zimbabwe, were randomised to receive six rounds of active case finding at 6-monthly intervals by either mobile van or door-to-door visits. Randomisation was done by selection of discs of two colours from an opaque bag, with one disc to represent every cluster, and one colour allocated to each intervention group before selection began. In both groups, adult (≥16 years) residents volunteering chronic cough (≥2 weeks) had two sputum specimens collected for fluorescence microscopy. Community health workers and cluster residents were not masked to intervention allocation, but investigators and laboratory staff were masked to allocation until final analysis. The primary outcome was the cumulative yield of smear-positive tuberculosis per 1000 adult residents, compared between intervention groups; analysis was by intention to treat. The secondary outcome was change in prevalence of culture-positive tuberculosis from before intervention to before round six of intervention in 12% of randomly selected households from the two intervention groups combined; analysis was based on participants who provided sputum in the two prevalence surveys. This trial is registered, number ISRCTN84352452. 46 study clusters were identified and randomly allocated equally between intervention groups, with 55 741 adults in the mobile van group and 54 691 in the door-to-door group at baseline. HIV prevalence was 21% (1916/9060) and in the 6 months before intervention the smear-positive case notification rate was 2·8 per 1000 adults per year. The trial was completed as planned with no adverse events. The mobile van detected 255 smear-positive patients from 5466 participants submitting sputum compared with 137 of 4711 participants identified through door-to-door visits (adjusted risk ratio 1·48, 95% CI 1·11–1·96, p=0·0087). The overall prevalence of culture-positive tuberculosis declined from 6·5 per 1000 adults (95% CI 5·1–8·3) to 3·7 per 1000 adults (2·6–5·0; adjusted risk ratio 0·59, 95% CI 0·40–0·89, p=0·0112). Wide implementation of active case finding, particularly with a mobile van approach, could have rapid effects on tuberculosis transmission and disease. Wellcome Trust.