Aurum Institute for Health Research, Johannesburg, South Africa.
AIDS. 2010 Nov;24 Suppl 5:S19-27. doi: 10.1097/01.aids.0000391018.72542.46.
This analysis describes the prevalence of and risk factors for tuberculosis at screening prior to isoniazid preventive therapy (IPT); the additional yield of tuberculosis using chest radiography versus symptoms alone, and risk factors for tuberculosis missed by screening.
Cross-sectional analysis of a trial of community-wide IPT in South African gold mines.
Participants were screened for tuberculosis prior to starting IPT using symptoms (cough >2 weeks, weight loss, night sweats) and chest radiography. Tuberculosis suspects had sputum collected for mycobacterial investigations. Those with a positive smear or culture with no speciation or culture identified as Mycobacterium tuberculosis were classified as having probable or definite tuberculosis, respectively. Among participants who were dispensed IPT, we defined a 'missed' case of active tuberculosis as one identified within 90 days of the enrolment screen.
Between July 2006 and December 2008, among 23,286 participants with complete data, the prevalence of undiagnosed tuberculosis [definite (284) and probable (31)] was high (315/23 286; 1.4%). The addition of chest radiography to symptom screening increased the number of definite tuberculosis cases detected by 2.5-fold (113 to 281 cases). Among 19,609 individuals correctly screened for tuberculosis who started IPT and had more than 90 days of follow-up, only 39 (0.2%) active tuberculosis cases were missed. Risk factors for tuberculosis missed by screening included increasing age [adjusted odds ratio (aOR) 1.66/10 year increase, 95% confidence interval (CI) 1.07-2.56], non-South African, in HIV care (aOR 4.80, 95% CI 1.63-14.1), lower weight (aOR 2.07/10 kg decrease, 95% CI 1.23-3.49) and alcohol use (aOR 2.52, 95% CI 1.31-4.86), which were similar to risk factors for tuberculosis detected by screening.
Tuberculosis screening prior to IPT detects a substantial burden of tuberculosis and misses very few cases. Chest radiography significantly increased the yield of tuberculosis cases detected.
本分析描述了异烟肼预防性治疗（IPT）前筛查中结核病的患病率和危险因素；与仅使用症状相比，胸部 X 射线检查对结核病的额外检出率，以及筛查遗漏的结核病危险因素。
南非金矿社区范围 IPT 试验的横断面分析。
参与者在开始 IPT 前使用症状（咳嗽>2 周、体重减轻、盗汗）和胸部 X 射线进行结核病筛查。疑似结核病者采集痰液进行分枝杆菌检查。那些痰涂片阳性或培养阳性但未鉴定或培养出结核分枝杆菌的患者，分别被归类为可能或确诊结核病。在接受 IPT 配药的参与者中，我们将活动性结核病的“漏诊”病例定义为在登记筛查后 90 天内确诊的病例。
2006 年 7 月至 2008 年 12 月，在 23286 名完成数据的参与者中，未确诊结核病[确诊（284 例）和可能（31 例）]的患病率较高（315/23286；1.4%）。将胸部 X 射线检查添加到症状筛查中，使确诊结核病的病例数增加了 2.5 倍（113 例至 281 例）。在 19609 名正确筛查结核病并随访超过 90 天的开始接受 IPT 的个体中，仅发现 39 例（0.2%）活动性结核病漏诊。筛查遗漏的结核病的危险因素包括年龄增加[校正优势比（aOR）每增加 10 岁为 1.66，95%置信区间（CI）为 1.07-2.56]、非南非人、HIV 治疗中（aOR 4.80，95%CI 1.63-14.1）、体重减轻（aOR 2.07/10kg 下降，95%CI 1.23-3.49）和饮酒（aOR 2.52，95%CI 1.31-4.86），与通过筛查发现的结核病危险因素相似。
IPT 前的结核病筛查发现了大量结核病病例，漏诊病例很少。胸部 X 射线检查显著提高了结核病病例的检出率。
