Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
Am J Public Health. 2013 Jul;103(7):1292-300. doi: 10.2105/AJPH.2012.300781. Epub 2012 Oct 18.
We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it.
In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project.
Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County.
Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States.
我们评估了一项针对受结核病（TB）影响最严重社区的预防策略。
1996 年，我们对德克萨斯州史密斯县报告的结核病病例（1985-1995 年）和结核菌素皮肤试验（TST）阳性反应者（1993-1995 年）进行了绘图。我们划定了最大、最密集的两个集群，确定了两个发病率最高的社区（180 个街区，3153 名居民）。在进行了广泛的社区准备后，经过培训的医疗保健工作者挨家挨户地为所有居民提供 TST 检测，除非有禁忌症。TST 阳性者被护送到移动诊所进行放射检查、临床评估和异烟肼预防治疗（IPT），视情况而定。为了评估长期影响，我们在项目实施后的等效时间段内对史密斯县的所有结核病病例进行了绘图。
在 2258 名符合条件的个体中，有 1291 人（57.1%）接受了检测，229 人（17.7%）TST 阳性，147 人接受了治疗。从 1996 年到 2006 年，两个项目社区都没有结核病病例，而在干预前十年和史密斯县其他地区仍在发生结核病。
针对高发社区进行积极的社区为基础的筛查和 IPT 可能会加速美国结核病的消除。
