Comparative Meta-Analysis of Tuberculosis Contact Investigation Interventions in Eleven High Burden Countries
Comparative Meta-Analysis of Tuberculosis Contact Investigation Interventions in Eleven High Burden Countries
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DOI：
10.1371/journal.pone.0119822
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发表时间：
2015-03-26
期刊：
影响因子：
3.7
通讯作者：
Bakker, Mirjam I.
中科院分区：
文献类型：
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作者：
Blok, Lucie;Sahu, Suvanand;Bakker, Mirjam I.
背景对结核病患者的家庭接触者进行筛查是提高早期病例发现的推荐策略。虽然它已经在低流行率国家广泛实施，但在高流行率、低资源环境下进行接触调查的最优方案尚未确定。这项研究评估了11个中低收入国家的接触调查干预措施，并回顾了背景或项目相关因素与接触者中病例产量之间的关联。方法我们回顾了19个第一波结核病REACH资助的试点项目的数据，这些项目旨在改进病例发现。这19人已达到资格标准：联系、调查、实施和完成数据报告。我们对每个项目的百分比收益和案例通知进行了横断面分析。结果19项干预措施共筛选出139,052名家庭接触者，镜检确诊病例(SS+)的百分率表现出极大的异质性(SS+)。与最严格的检测标准(至少咳嗽2周)相比，较轻(任何结核病相关症状)和最少(所有接触者)限制检测标准的AOR分别为1.71(95%CI 0.94~3.13)和6.90(95%CI 3.42~13.93)。与将指标病例限制为SS+TB相比，纳入SS-和肺外结核的AOR为0.31(95%CI为0.15-0.62)。接触调查在干预地区确诊的所有SS+病例中占1%-14%。结论本研究证实，在各种情况下，通过接触调查可以发现大量的活动性结核病病例。然而，设计和规划实施因素似乎影响接触调查的成果及其对结核病病例发现的贡献。
BackgroundScreening of household contacts of tuberculosis (TB) patients is a recommended strategy to improve early case detection. While it has been widely implemented in low prevalence countries, the most optimal protocols for contact investigation in high prevalence, low resource settings is yet to be determined. This study evaluated contact investigation interventions in eleven lower and middle income countries and reviewed the association between context or program-related factors and the yield of cases among contacts.MethodsWe reviewed data from nineteen first wave TB REACH funded projects piloting innovations to improve case detection. These nineteen had fulfilled the eligibility criteria: contact investigation implementation and complete data reporting. We performed a cross-sectional analysis of the percentage yield and case notifications for each project. Implementation strategies were delineated and the association between independent variables and yield was analyzed by fitting a random effects logistic regression.FindingsOverall, the nineteen interventions screened 139,052 household contacts, showing great heterogeneity in the percentage yield of microscopy confirmed cases (SS+), ranging from 0.1% to 6.2%). Compared to the most restrictive testing criteria (at least two weeks of cough) the aOR's for lesser (any TB related symptom) and least (all contacts) restrictive testing criteria were 1.71 (95% CI 0.94 -3.13) and 6.90 (95% CI 3.42 -13.93) respectively. The aOR for inclusion of SS-and extra-pulmonary TB was 0.31 (95% CI 0.15 -0.62) compared to restricting index cases to SS+ TB. Contact investigation contributed between < 1% and 14% to all SS+ cases diagnosed in the intervention areas.ConclusionsThis study confirms that high numbers of active TB cases can be identified through contact investigation in a variety of contexts. However, design and program implementation factors appear to influence the yield of contact investigation and its concomitant contribution to TB case detection.