Carraher Sally, Chang Hsiu-Ju, Munday Rachel, Goodman Karen J
Department of Anthropology, McMaster University, Hamilton, Canada.
Int J Circumpolar Health. 2013 Aug 5;72. doi: 10.3402/ijch.v72i0.21594. eCollection 2013.
The Aklavik H. pylori Project (AHPP) (www.canhelpworkinggroup.ca) is a community-driven project examining Helicobacter pylori infection and its influence on health in a diverse Aboriginal community in the Northwest Territories. Initial research revealed that 58% of 333 participants who underwent a urea breath test (UBT) between 2007 and 2010 were H. pylori-positive. From 2008 to 2010, we offered treatment to H. pylori-positive participants and 113 consented to this treatment.
We estimated H. pylori incidence in AHPP participants who initially tested negative and the re-infection frequency in initially positive participants who were successfully treated to clear the infection.
Participants who were initially H. pylori-negative or negative after treatment during 2008-2010 were eligible for inclusion. From November 2011 to June 2012, participants were offered a UBT and the samples were analyzed using infrared spectroscopy (IRIS). Participants with a positive test result were classified as new cases for estimating incidence among participants testing negative at baseline and re-infection among those successfully treated for H. pylori infection.
Among 38 initially negative participants, follow-up UBT showed that 33 remained negative, 3 were positive, and 2 had uncertain status. The estimated incidence proportion during the follow-up period was 8.3% (95% CI: 1.8-22.0%). Among 43 participants with a negative post-treatment UBT, 41 remained negative and 2 were positive. The estimated re-infection proportion during the follow-up period was 4.7% (95% CI: 0.6-16.0%). The frequency of new cases was similar in males and females. Aboriginal participants had a combined re-infection/incidence rate of 2.4% per year (95% CI: 0.8-5.9% per year). All 9 non-Aboriginal participants remained free from infection throughout the study period, as did all 23 participants aged 55 years and above.
The AHPP has substantially reduced the burden of infection in Aklavik since 2008. Continued monitoring, treatment, community engagement and knowledge translation activities are needed to ensure a lasting benefit of the project.
我们估计了AHPP中最初检测为阴性的参与者的幽门螺杆菌发病率，以及最初检测为阳性且成功治疗清除感染的参与者的再次感染频率。
2008年至2010年期间最初幽门螺杆菌检测为阴性或治疗后检测为阴性的参与者符合纳入条件。2011年11月至2012年6月，为参与者提供了UBT检测，并使用红外光谱法（IRIS）对样本进行分析。检测结果呈阳性的参与者被归类为新病例，用于估计基线检测为阴性的参与者中的发病率以及成功治疗幽门螺杆菌感染的参与者中的再次感染率。
在38名最初检测为阴性的参与者中，随访期间的UBT检测显示，33人仍为阴性，3人呈阳性，2人结果不确定。随访期间估计的发病率为8.3%（95%置信区间：1.8 - 22.0%）。在43名治疗后UBT检测为阴性的参与者中，41人仍为阴性，2人呈阳性。随访期间估计的再次感染率为4.7%（95%置信区间：0.6 - 16.0%）。新发病例的频率在男性和女性中相似。原住民参与者的综合再次感染/发病率为每年2.4%（95%置信区间：每年0.8 - 5.9%）。在整个研究期间，所有9名非原住民参与者均未感染，所有23名55岁及以上的参与者也是如此。
自2008年以来，AHPP已大幅减轻了阿克拉维克的感染负担。需要持续进行监测、治疗、社区参与和知识转化活动，以确保该项目能带来持久的益处。
