Active Tuberculosis Case Finding in Port-au-Prince, Haiti: Experiences, Results, and Implications for Tuberculosis Control Programs.
Active Tuberculosis Case Finding in Port-au-Prince, Haiti: Experiences, Results, and Implications for Tuberculosis Control Programs.
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DOI：
10.1155/2016/8020745
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发表时间：
2016
影响因子：
--
通讯作者：
Buchwald UK
中科院分区：
文献类型：
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作者：
Delva GJ;Francois I;Claassen CW;Dorestan D;Bastien B;Medina-Moreno S;Fort DS;Redfield RR;Buchwald UK
背景海地是美洲结核病发病率最高的国家，每10万人中有254例。病例检测依赖于被动检测，许多地区的结核病服务缺乏诊断和临床资源。方法. Mache Chache（“Go and Seek”）是2013年7月至2014年9月期间在太子港开展的结核病REACH第3波资助的结核病病例发现项目，目标是结核病诊断能力不足的四个干预地区。结果根据强调咳嗽存在的口头症状筛查，该项目确定所有筛查者中有11 150人（11.75%）为结核病患者，2.67%为涂片阳性（SS+）结核病病例。加强病例发现和加强实验室服务导致评价人群中细菌学确诊病例增加了59%。此外，涂片等级显著下降，表明早期发现病例。Xpert® MTB/RIF已成功引入，并改善了HIV感染、涂片阴性门诊患者的结核病诊断，但未改善社区HIV阴性、涂片阴性结核病疑似患者的诊断。然而，筛查一个额外的SS+病例所需的数量在诊所和社区筛查活动之间差异很大。结论在海地加强和积极发现结核病病例可以改善结核病诊断和护理。然而，筛选算法必须根据个人情况量身定制，需要长期承诺。
Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources. Methods. Mache Chache (“Go and Seek”) was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance. Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities. Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment.