Active Tuberculosis Case-Finding Among Pregnant Women Presenting to Antenatal Clinics in Soweto, South Africa
Active Tuberculosis Case-Finding Among Pregnant Women Presenting to Antenatal Clinics in Soweto, South Africa
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DOI：
10.1097/qai.0b013e31821ac9c1
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发表时间：
2011-08-01
影响因子：
3.6
通讯作者：
Martinson, Neil A.
中科院分区：
文献类型：
--
作者：
Gounder, Celine R.;Wada, Nikolas I.;Martinson, Neil A.
背景：人类免疫缺陷病毒（HIV）和结核病（TB）是全世界育龄妇女死亡的主要原因。结核病是孕产妇发病的一个重要原因。在怀孕期间检测结核病可以为妇女及其子女带来实质性的好处。方法：这是一项横断面实施研究，在南非索韦托的6家诊所将活动性结核病病例发现纳入现有的产前和预防母婴传播服务。所有到这些公共诊所接受常规护理的18岁或以上孕妇，无论其艾滋病毒状况如何，均对活动性结核病症状、咳嗽2周或更长时间、咳痰、发烧、盗汗或体重减轻进行筛查。有活动性结核症状的参与者被要求提供痰标本进行涂片镜检、分枝杆菌培养和药敏试验。结果：2008年12月至2009年7月，共有3963名孕妇参与了结核病筛查，其中1454名（36.7%）为hiv血清阳性。23.1%的hiv血清阳性妇女报告有结核症状，13.8%的hiv血清阴性妇女报告有结核症状（P < 0.01）。1454名hiv血清阳性妇女中有10人（每10万人中有688人）被诊断为活动性肺结核，2483名hiv血清阴性妇女中有5人（每10万人中有201人，P = 0.03）被诊断为活动性肺结核。艾滋病毒血清阳性的结核病妇女的中位CD4(+) t细胞计数与无结核病的艾滋病毒血清阳性妇女相似（352个细胞/mL对333个细胞/mL， P = 0.85）。结论：hiv血清阳性孕妇活动性结核负担较高。结核病筛查和提供异烟肼预防治疗和抗逆转录病毒治疗应与预防母婴传播服务相结合。
Background: Human immunodeficiency virus (HIV) and tuberculosis (TB) are among the leading causes of death among women of reproductive age worldwide. TB is a significant cause of maternal morbidity. Detection of TB during pregnancy could provide substantial benefits to women and their children.Methods: This was a cross-sectional implementation research study of integrating active TB case-finding into existing antenatal and prevention of mother-to-child transmission services in six clinics in Soweto, South Africa. All pregnant women 18 years of age or older presenting for routine care to these public clinics were screened for symptoms of active TB, cough for 2 weeks or longer, sputum production, fevers, night sweats, or weight loss, regardless of their HIV status. Participants with any symptom of active TB were asked to provide a sputum specimen for smear microscopy, mycobacterial culture and drug-susceptibility testing.Results: Between December 2008 and July 2009, 3963 pregnant women were enrolled and screened for TB, of whom 1454 (36.7%) were HIV-seropositive. Any symptom of TB was reported by 23.1% of HIV-seropositive and 13.8% of HIV-seronegative women (P, 0.01). Active pulmonary TB was diagnosed in 10 of 1454 HIV-seropositve women (688 per 100,000) and 5 of 2483 HIV-seronegative women (201 per 100,000, P = 0.03). The median CD4(+) T-cell count among HIV-seropositive women with TB was similar to that of HIV-seropositive women without TB (352 versus 333 cells/mL, P = 0.85).Conclusions: There is a high burden of active TB among HIV-seropositive pregnant women. TB screening and provision of isoniazid preventive therapy and antiretroviral therapy should be integrated with prevention of mother-to-child transmission services.