Department of Health, Department of Infectious Diseases, Health Protection Authority, City of Frankfurt am Main, Breite Gasse 28, 60313 Frankfurt am Main, Germany.
Infection. 2012 Aug;40(4):389-95. doi: 10.1007/s15010-011-0238-x. Epub 2012 Jan 12.
Illicit drug use and homelessness are major contributors to the incidence of tuberculosis (TB) among inhabitants of major cities.
The primary objective of this study was to establish a sustainable low-threshold chest X-ray screening programme for pulmonary TB among illicit drug users and homeless persons and to integrate this into the existing public health programme for active case finding. A secondary objective was to estimate the coverage of the programme, assess other risk factors and determine TB rates and treatment outcome in these two groups.
Illicit drug users and homeless persons were asked to voluntarily participate in an X-ray screening programme. The coverage of the intervention, total number and characteristics of cases and the follow-up of treatment were assessed.
A total of 4,529 chest radiographs were made from 3,477 persons, of whom 66% were homeless and 34% were illicit drug users, between May 2002 and April 2007. Coverage for screening once every 2 years ranged between 18 and 26%. Thirty-nine TB cases (14 drug users, 25 homeless persons) were identified, representing 8.7% of the total case load of 448 notified cases of pulmonary TB in Frankfurt during this period. Among the drug users, human immunodeficiency virus coinfection (10/14) seemed to play a key role in the development of TB. The case-finding rate of 861/100,000 radiographs (1,122/100,000 persons) is as high as that in routine contact investigations (1,078/100,000). Among all individuals with TB, 76% completed treatment.
A novel targeted TB screening approach with voluntary radiographic examination of illicit drug users and homeless persons can be integrated into the existing public TB prevention programme and provides a high case-finding rate.
非法药物使用和无家可归是导致主要城市居民结核病（TB）发病率上升的主要因素。
本研究的主要目的是为非法药物使用者和无家可归者建立可持续的低门槛胸部 X 光筛查计划，以发现潜在的肺结核病例，并将其纳入现有的公共卫生主动筛查计划中。次要目标是评估该计划的覆盖范围，评估其他风险因素，并确定这两个群体的结核病发病率和治疗结果。
邀请非法药物使用者和无家可归者自愿参加 X 光筛查计划。评估干预措施的覆盖范围、病例总数和特征以及治疗的随访情况。
2002 年 5 月至 2007 年 4 月期间，共有 3477 人接受了 4529 次胸部 X 光检查，其中 66%为无家可归者，34%为非法药物使用者。每两年筛查一次的覆盖率在 18%至 26%之间。共发现 39 例结核病病例（14 例为药物使用者，25 例为无家可归者），占同期法兰克福 448 例肺结核通报病例总数的 8.7%。在药物使用者中，人类免疫缺陷病毒（HIV）合并感染（14 例中的 10 例）似乎在结核病的发展中起着关键作用。X 光检查的发现率为 861/10 万（1078/10 万），与常规接触调查的发现率（1078/10 万）相当。所有结核病患者中，有 76%完成了治疗。
一种新型的有针对性的结核病筛查方法，对非法药物使用者和无家可归者进行自愿的放射学检查，可以整合到现有的公共结核病预防计划中，并提供高的发现率。
