Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi.
Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi.
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DOI：
10.1371/journal.pone.0268749
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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作者：
需要地方信息来指导针对肺结核等呼吸道感染的干预措施。病例报告率（CNRs）是现成的，但系统地低估了真正的疾病负担，在社区的高诊断准入障碍。我们探索了一种新的方法，使用结核病患病率与报告率的邻里水平预测因子调整通知不足（P：N比）的CNR。我们分析了以下数据：1）2015- 2019年期间马拉维布兰太尔所有登记的结核病患者的全市常规结核病监测系统，包括地理位置、确证性分枝杆菌学以及临床和人口统计学特征; 2）2019年进行的成人结核病患病率调查。在患病率调查中，来自72个社区随机选择的家庭的同意成年人进行了胸部X线筛查，并通过痰涂片显微镜检查、Xpert MTB/Rif和培养进行了确认。贝叶斯多水平模型用于估计调整后的邻里患病率与通知比，根据拟合的成人细菌学证实的TB CNR和患病率的总结后验图。从2015年至2019年，经细菌学确认的成人CNR为131（479/371，834）、134（539/415，226）、114（519/463，707）、56（283/517，860）和46（258/578，377）/100，000成人每年，2019年细菌学确认的患病率为215（29/13，490）/100，000成人。较低的教育成就，户主和社区距离结核病诊所呈负相关。平均邻里P：N比为4.49（95%可信区间[CrI]：0.98-11.91），与结核病诊断不足一致，在非正式的城郊社区最为明显。在这里，我们展示了一种方法，用于识别结核病诊断不足的社区，而不需要进行流行率调查;这是很重要的，因为流行率调查是昂贵的，后勤上的挑战。如果得到证实，这种方法可能有助于更有效和更有效率地加强结核病和艾滋病毒病例发现干预措施，以加速消除城市结核病。
Local information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel approach, adjusting CNRs for under-notification (P:N ratio) using neighbourhood-level predictors of TB prevalence-to-notification ratios. We analysed data from 1) a citywide routine TB surveillance system including geolocation, confirmatory mycobacteriology, and clinical and demographic characteristics of all registering TB patients in Blantyre, Malawi during 2015–19, and 2) an adult TB prevalence survey done in 2019. In the prevalence survey, consenting adults from randomly selected households in 72 neighbourhoods had symptom-plus-chest X-ray screening, confirmed with sputum smear microscopy, Xpert MTB/Rif and culture. Bayesian multilevel models were used to estimate adjusted neighbourhood prevalence-to-notification ratios, based on summarised posterior draws from fitted adult bacteriologically-confirmed TB CNRs and prevalence. From 2015–19, adult bacteriologically-confirmed CNRs were 131 (479/371,834), 134 (539/415,226), 114 (519/463,707), 56 (283/517,860) and 46 (258/578,377) per 100,000 adults per annum, and 2019 bacteriologically-confirmed prevalence was 215 (29/13,490) per 100,000 adults. Lower educational achievement by household head and neighbourhood distance to TB clinic was negatively associated with CNRs. The mean neighbourhood P:N ratio was 4.49 (95% credible interval [CrI]: 0.98–11.91), consistent with underdiagnosis of TB, and was most pronounced in informal peri-urban neighbourhoods. Here we have demonstrated a method for the identification of neighbourhoods with high levels of under-diagnosis of TB without the requirement for a prevalence survey; this is important since prevalence surveys are expensive and logistically challenging. If confirmed, this approach may support more efficient and effective targeting of intensified TB and HIV case-finding interventions aiming to accelerate elimination of urban TB.
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DOI：
10.1016/s2468-2667(21)00033-5
发表时间：
2021-05
期刊：
The Lancet. Public health
影响因子：
--
作者：
Burke RM;Nliwasa M;Feasey HRA;Chaisson LH;Golub JE;Naufal F;Shapiro AE;Ruperez M;Telisinghe L;Ayles H;Corbett EL;MacPherson P
通讯作者：
MacPherson P
马拉维城市布兰蒂尔的结核病病死的临床，卫生系统和邻里决定因素：增强监视数据的多级流行病学分析
影响因子：
4.2
作者：
Khundi M;MacPherson P;Feasey HR;Nzawa Soko R;Nliwasa M;Corbett EL;Carpenter JR
通讯作者：
Carpenter JR
影响因子：
11.8
作者：
Borgdorff, MW
通讯作者：
Borgdorff, MW
影响因子：
158.5
作者：
Marks, Guy B.;Nguyen, Nhung V.;Fox, Greg J.
通讯作者：
Fox, Greg J.
影响因子：
168.9
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.
通讯作者：
Hayes, Richard J.