印度、尼泊尔和孟加拉国流行地区内脏利什曼病主动病例检测的选择，比较其检出率、可行性和成本。
Options for active case detection of visceral leishmaniasis in endemic districts of India, Nepal and Bangladesh, comparing yield, feasibility and costs.
机构信息
Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
出版信息
PLoS Negl Trop Dis. 2011 Feb 8;5(2):e960. doi: 10.1371/journal.pntd.0000960.
BACKGROUND
The VL elimination strategy requires cost-effective tools for case detection and management. This intervention study tests the yield, feasibility and cost of 4 different active case detection (ACD) strategies (camp, index case, incentive and blanket approach) in VL endemic districts of India, Nepal and Bangladesh.
METHODOLOGY/PRINCIPAL FINDINGS: First, VL screening (fever more than 14 days, splenomegaly, rK39 test) was performed in camps. This was followed by house to house screening (blanket approach). An analysis of secondary VL cases in the neighborhood of index cases was simulated (index case approach). A second screening round was repeated 4-6 months later. In another sub-district in India and Nepal, health workers received incentives for detecting new VL cases over a 4 month period (incentive approach). This was followed by house screening for undetected cases. A total of 28 new VL cases were identified by blanket approach in the 1(st) screening round, and used as ACD gold standard. Of these, the camp approach identified 22 (sensitivity 78.6%), index case approach identified 12 (sensitivity--42.9%), and incentive approach identified 23 new VL cases out of 29 cases detected by the house screening (sensitivity--79.3%). The effort required to detect a new VL case varied (blanket approach--1092 households, incentive approach--978 households; index case approach--788 households had to be screened). The cost per new case detected varied (camp approach $21 - $661; index case approach $149 - $200; incentive based approach $50 - $543; blanket screening $112 - $629). The 2(nd) screening round yielded 20 new VL cases. Sixty and nine new PKDL cases were detected in the first and second round respectively.
CONCLUSIONS/SIGNIFICANCE: ACD in the VL elimination campaign has a high yield of new cases at programme costs which vary according to the screening method chosen. Countries need the right mix of approaches according to the epidemiological profile, affordability and organizational feasibility.
背景
VL 消除策略需要具有成本效益的工具来进行病例检测和管理。本干预研究在印度、尼泊尔和孟加拉国的 VL 流行地区测试了 4 种不同主动病例检测（ACD）策略（营地、索引病例、激励和 blanket 方法）的效果、可行性和成本。
方法/主要发现：首先，在营地进行 VL 筛查（发热超过 14 天、脾肿大、rK39 试验）。随后进行挨家挨户筛查（blanket 方法）。模拟了对索引病例附近的二级 VL 病例的分析（索引病例方法）。4-6 个月后重复进行第二轮筛查。在印度和尼泊尔的另一个分区，卫生工作者在 4 个月内因发现新的 VL 病例而获得奖励（激励方法）。随后对未发现的病例进行家庭筛查。第一轮筛查中通过 blanket 方法共发现 28 例新的 VL 病例，作为 ACD 的金标准。其中，营地方法检出 22 例（敏感性 78.6%），索引病例方法检出 12 例（敏感性 42.9%），激励方法从 29 例经家庭筛查发现的病例中检出 23 例新的 VL 病例（敏感性 79.3%）。检测新的 VL 病例所需的努力不同（blanket 方法需要筛查 1092 户家庭，激励方法需要筛查 978 户家庭，索引病例方法需要筛查 788 户家庭）。检测到新病例的成本也不同（营地方法为 21-661 美元，索引病例方法为 149-200 美元，基于激励的方法为 50-543 美元， blanket 筛查为 112-629 美元）。第二轮筛查发现 20 例新的 VL 病例。第一轮和第二轮分别发现 60 例和 9 例新的 PKDL 病例。
结论/意义：在 VL 消除运动中，ACD 在项目成本范围内具有较高的新病例检出率，而成本则根据所选的筛查方法而有所不同。各国需要根据流行病学特征、可负担性和组织可行性，选择合适的方法组合。
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