Drop-out from the tuberculosis contact investigation cascade in a routine public health setting in urban Uganda: A prospective, multi-center study
Drop-out from the tuberculosis contact investigation cascade in a routine public health setting in urban Uganda: A prospective, multi-center study
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DOI：
10.1371/journal.pone.0187145
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发表时间：
2017-11-06
期刊：
影响因子：
3.7
通讯作者：
Davis, J. Lucian
中科院分区：
文献类型：
--
作者：
Armstrong-Hough, Mari;Turimumahoro, Patricia;Davis, J. Lucian
乌干达坎帕拉的七个公共结核病（TB）单位，乌干达国家结核病规划最近根据2012年WHO指南的建议引入了家庭接触调查。目的应用级联分析在规划环境中实施家庭接触调查。设计前瞻性，多中心观察性研究。方法我们构建了家庭接触调查的级联，以描述以下比例：1）索引患者家庭招募; 2）索引患者家庭访问; 3）接触筛选结核病;和4）接触完成评估，并诊断为活动性TB。结果338（33%）的1022例连续索引TB患者有资格进行接触调查。非专业卫生工作者为207名（61%）索引患者安排了家访，并完成了104名（50%）。在287名符合条件的接触者中，他们对256名（89%）进行了结核病症状或风险因素筛查。131例（51%）有进一步结核病评估的指征。其中包括59名（45%）仅有症状，58名（44%）5岁以下儿童和14名（11%）艾滋病毒感染者。在发现有症状或有风险的131名接触者中，26名（20%）接触者完成了评估，其中包括5名（19%）被诊断为活动性结核病并接受治疗，总收率为1.7%。结论通过提高指标家庭完成非专业卫生工作者筛查访视的比例和高危接触者完成结核病评估的比例，可以提高结核病接触者调查的有效性和产出率。
SettingSeven public tuberculosis (TB) units in Kampala, Uganda, where Uganda's national TB program recently introduced household contact investigation, as recommended by 2012 guidelines from WHO.ObjectiveTo apply a cascade analysis to implementation of household contact investigation in a programmatic setting.DesignProspective, multi-center observational study.MethodsWe constructed a cascade for household contact investigation to describe the proportions of: 1) index patient households recruited; 2) index patient households visited; 3) contacts screened for TB; and 4) contacts completing evaluation for, and diagnosed with, active TB.Results338 (33%) of 1022 consecutive index TB patients were eligible for contact investigation. Lay health workers scheduled home visits for 207 (61%) index patients and completed 104 (50%). Among 287 eligible contacts, they screened 256 (89%) for symptoms or risk factors for TB. 131 (51%) had an indication for further TB evaluation. These included 59 (45%) with symptoms alone, 58 (44%) children < 5, and 14 (11%) with HIV. Among 131 contacts found to be symptomatic or at risk, 26 (20%) contacts completed evaluation, including five (19%) diagnosed with and treated for active TB, for an overall yield of 1.7%. The cumulative conditional probability of completing the entire cascade was 5%.ConclusionMajor opportunities exist for improving the effectiveness and yield of TB contact investigation by increasing the proportion of index households completing screening visits by lay health workers and the proportion of at-risk contacts completing TB evaluation.