Prevalence of bacteriologically confirmed pulmonary tuberculosis in South Africa, 2017-19: a multistage, cluster-based, cross-sectional survey.
Prevalence of bacteriologically confirmed pulmonary tuberculosis in South Africa, 2017-19: a multistage, cluster-based, cross-sectional survey.
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DOI：
10.1016/s1473-3099(22)00149-9
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发表时间：
2022-08
影响因子：
56.3
通讯作者：
Mvusi, Lindiwe
中科院分区：
文献类型：
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作者：
Moyo, Sizulu;Ismail, Farzana;Van der Walt, Martie;Ismail, Nazir;Mkhondo, Nkateko;Dlamini, Sicelo;Mthiyane, Thuli;Chikovore, Jeremiah;Oladimeji, Olanrewaju;Mametja, David;Maribe, Phaleng;Seocharan, Ishen;Ximiya, Phumlani;Law, Irwin;Tadolini, Marina;Zuma, Khangelani;Manda, Samuel;Sismanidis, Charalambos;Pillay, Yogan;Mvusi, Lindiwe
结核病仍然是南非的一个重要的临床和公共卫生问题，南非是世界上结核病负担最高的国家之一。我们的目的是估计南非 15 岁或以上人群中经细菌学证实的肺结核的负担。这项多阶段、集群式、横断面调查纳入了全国 110 个集群（集群规模为 500 人；通过与人口规模成比例的概率抽样进行选择）中符合条件的居民（年龄 ≥ 15 岁，过去两周在房屋中睡过 ≥ 10 晚）。参与者完成了面对面的症状调查问卷（咳嗽、体重减轻、发烧和盗汗）并手动阅读数字胸部 X 光筛查。如果参与者至少有一种症状或胸部 X 光检查异常提示结核病，或其组合，则筛查结果为阳性。通过 Xpert MTB/RIF Ultra 检测（第一个样本）和分枝杆菌生长指示管培养（第二个样本）对筛查呈阳性的参与者的痰样本进行检测，并可选择进行 HIV 检测。结核分枝杆菌复合体培养呈阳性的参与者被认为是细菌学确诊的肺结核阳性；当培养结果不呈阳性时，Xpert MTB/RIF Ultra 结果呈阳性且胸部 X 线检查异常提示活动性结核病且当前或既往没有结核病的参与者被视为经细菌学证实的肺结核呈阳性。 2017年8月15日至2019年7月28日，共统计了110个集群的68 771人，其中53 250人符合调查条件，其中35 191人（66·1%）参与了调查。 35 191 名参与者中有 9066 名 (25·8%) 筛查呈阳性，234 名 (0·7%) 经细菌学证实患有肺结核。总体而言，经细菌学证实的肺结核患病率估计为每 100 万人中有 852 例（95% CI 679-1026）； 35-44 岁人群（每 100 万人中有 1107 例 [95% CI 703-1511]）和 65 岁或以上人群（每 100 万人有 1104 例 [680-1528]）患病率最高。估计男性患病率大约比女性高 1·6 倍（每 100000 人中有 1094 例 [95% CI 835–1352]，而每 100000 人中有 675 例 [95% CI 835–1352]）。 234 名结核病参与者中，有 135 名（57·7%）仅通过胸部 X 光检查呈阳性，16 名（6·8%）仅通过症状筛查呈阳性，82 名（35·9%）通过两者均筛查呈阳性。 191 名已知 HIV 感染状况的结核病参与者中有 55 名 (28·8%) HIV 呈阳性。本次调查中肺结核患病率较高，尤其是男性。尽管艾滋病毒负担持续存在，但本次调查中许多患有结核病的参与者并未感染艾滋病毒。由于超过一半的结核病参与者的胸部 X 光检查异常但没有症状，因此优先进行胸部 X 光筛查可以大大增加病例发现率。全球基金、比尔及梅琳达·盖茨基金会、美国国际开发署。
Tuberculosis remains an important clinical and public health issue in South Africa, which has one of the highest tuberculosis burdens in the world. We aimed to estimate the burden of bacteriologically confirmed pulmonary tuberculosis among people aged 15 years or older in South Africa. This multistage, cluster-based, cross-sectional survey included eligible residents (age ≥15 years, who had slept in a house for ≥10 nights in the preceding 2 weeks) in 110 clusters nationally (cluster size of 500 people; selected by probability proportional-to-population size sampling). Participants completed face-to-face symptom questionnaires (for cough, weight loss, fever, and night sweats) and manually read digital chest X-ray screening. Screening was recorded as positive if participants had at least one symptom or an abnormal chest X-ray suggestive of tuberculosis, or a combination thereof. Sputum samples from participants who were screen-positive were tested by the Xpert MTB/RIF Ultra assay (first sample) and Mycobacteria Growth Indicator Tube culture (second sample), with optional HIV testing. Participants with a positive Mycobacterium tuberculosis complex culture were considered positive for bacteriologically confirmed pulmonary tuberculosis; when culture was not positive, participants with a positive Xpert MTB/RIF Ultra result with an abnormal chest X-ray suggestive of active tuberculosis and without current or previous tuberculosis were considered positive for bacteriologically confirmed pulmonary tuberculosis. Between Aug 15, 2017, and July 28, 2019, 68 771 people were enumerated from 110 clusters, with 53 250 eligible to participate in the survey, of whom 35 191 (66·1%) participated. 9066 (25·8%) of 35 191 participants were screen-positive and 234 (0·7%) were identified as having bacteriologically confirmed pulmonary tuberculosis. Overall, the estimated prevalence of bacteriologically confirmed pulmonary tuberculosis was 852 cases (95% CI 679–1026) per 100 000 population; the prevalence was highest in people aged 35–44 years (1107 cases [95% CI 703–1511] per 100 000 population) and those aged 65 years or older (1104 cases [680–1528] per 100 000 population). The estimated prevalence was approximately 1·6 times higher in men than in women (1094 cases [95% CI 835–1352] per 100 000 population vs 675 cases [494–855] per 100 000 population). 135 (57·7%) of 234 participants with tuberculosis screened positive by chest X-ray only, 16 (6·8%) by symptoms only, and 82 (35·9%) by both. 55 (28·8%) of 191 participants with tuberculosis with known HIV status were HIV-positive. Pulmonary tuberculosis prevalence in this survey was high, especially in men. Despite the ongoing burden of HIV, many participants with tuberculosis in this survey did not have HIV. As more than half of the participants with tuberculosis had an abnormal chest X-ray without symptoms, prioritising chest X-ray screening could substantially increase case finding. Global Fund, Bill & Melinda Gates Foundation, USAID.