Screening and treatment of latent tuberculosis in a cohort of asylum seekers in Norway
Screening and treatment of latent tuberculosis in a cohort of asylum seekers in Norway
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DOI：
10.1177/1403494809353823
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发表时间：
2010-05-01
影响因子：
3.4
通讯作者：
Jacobsen, Geir W.
中科院分区：
文献类型：
--
作者：
Harstad, Ingunn;Heldal, Einar;Jacobsen, Geir W.
目的：寻求庇护者在进入挪威时接受肺结核检查。我们的目的是评估不同医疗保健水平的筛查结果的随访，与人口统计学、筛查结果和组织因素的关系，以及这如何影响潜伏性结核病的治疗。研究方法：所有在2005年1月至2006年6月期间抵达国家接待中心的年满18岁、曼图测试结果大于等于6毫米或X光检查结果呈阳性的寻求庇护者都包括在内。数据是从寻求庇护者移居的城市的公共卫生当局收集的，如果他们被转介给专家，则从内科医生收集。专科医生负责治疗潜伏性肺结核。每个受试者都与国家结核病登记册相匹配，每个开始治疗潜伏性结核病的人都被报告。结果：在4，643名寻求庇护者中，有2，237人符合纳入标准。到2008年5月，30人开始治疗潜伏性结核病，平均治疗时间为抵达后17个月（3-36个月）。到达时Mantoux试验>= 15 mm与治疗显著相关。人口统计学因素影响了初级卫生保健的随访，而筛查结果则没有影响。转诊至专科医生与筛查结果相关。一些专家不愿意诊断和治疗潜伏性肺结核，特别是不愿意治疗没有永久签证的人。结论：研究组中只有1%的人接受了潜伏性结核病的治疗，而且治疗时间很长。其原因可能是影响随访和转诊的组织因素以及专家不遵守现行指南。
Aims: Asylum seekers are screened for tuberculosis at entry to Norway. We aimed to assess follow-up of screening results at different healthcare levels in relation to demographics, screening results and organizational factors, and how this influenced treatment of latent tuberculosis. Methods: All asylum seekers >= 18 years with a Mantoux test >= 6 mm or positive x-ray findings who arrived at the National Reception Centre from January 2005 to June 2006, were included. Data were collected from public health authorities in the municipality where the asylum seekers had moved, and from internists in case they had been referred to a specialist. Specialists are responsible for treating latent tuberculosis. Individual subjects were matched with the National Tuberculosis Register to which everybody who had started treatment for latent tuberculosis was reported. Results: Of 4,643 asylum seekers, 2,237 fulfilled the inclusion criteria. By May 2008, 30 persons had started treatment for latent TB, a median of 17 months (range 3-36) after arrival. A Mantoux test >= 15 mm on arrival was significantly associated with treatment. Demographic factors influenced follow-up in primary healthcare while screening results did not. Referral to specialist was related to screening results. Several specialists were reluctant to diagnose and treat latent tuberculosis and to treat persons without a permanent visa in particular. Conclusions: Just 1% of the study group received treatment for latent tuberculosis and with a long time delay. The reason for this may be organizational factors affecting follow-up and referral and specialists not following current guidelines.