Assessing Local Risk of Rifampicin-Resistant Tuberculosis in KwaZulu-Natal, South Africa Using Lot Quality Assurance Sampling.
Assessing Local Risk of Rifampicin-Resistant Tuberculosis in KwaZulu-Natal, South Africa Using Lot Quality Assurance Sampling.
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DOI：
10.1371/journal.pone.0153143
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Cohen T
中科院分区：
文献类型：
--
作者：
Heidebrecht CL;Podewils LJ;Pym A;Mthiyane T;Cohen T
在南非，夸祖鲁-纳塔尔省通报的耐多药结核病（MDR TB）和广泛耐药结核病病例负担最重。更好地了解耐药风险的空间异质性可能有助于优先考虑局部反应。在2012年7月至2013年6月期间，我们开展了一项双向批次质量保证抽样（LQAS）研究，对KZN北部两个区和南部一个区七个实验室集水区报告的结核病病例中利福平耐药结核病的负担进行分类。将RIF耐药结核病高风险或低风险地区分类的决策规则（根据RIF耐药在所有结核病病例中的比例）是基于与当地决策者的协商制定的。我们将五个地区划分为高风险地区，两个地区划分为低风险地区。在南部和北部地区都确定了高风险地区，在最北部地区，即位于莫桑比克边境的Manguzi社区，观察到的RIF耐药性比例最大。我们的研究揭示了KZN地区结核病例中RIF耐药疾病风险的异质性。本研究证明了LQAS在药敏试验有限的地区检测地理异质性的潜力。
KwaZulu-Natal (KZN) has the highest burden of notified multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant (XDR) TB cases in South Africa. A better understanding of spatial heterogeneity in the risk of drug-resistance may help to prioritize local responses. Between July 2012 and June 2013, we conducted a two-way Lot Quality Assurance Sampling (LQAS) study to classify the burden of rifampicin (RIF)-resistant TB among incident TB cases notified within the catchment areas of seven laboratories in two northern and one southern district of KZN. Decision rules for classification of areas as having either a high- or low-risk of RIF resistant TB (based on proportion of RIF resistance among all TB cases) were based on consultation with local policy makers. We classified five areas as high-risk and two as low-risk. High-risk areas were identified in both Southern and Northern districts, with the greatest proportion of RIF resistance observed in the northernmost area, the Manguzi community situated on the Mozambique border. Our study revealed heterogeneity in the risk of RIF resistant disease among incident TB cases in KZN. This study demonstrates the potential for LQAS to detect geographic heterogeneity in areas where access to drug susceptibility testing is limited.