1University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Health Educ Behav. 2013 Oct;40(1 Suppl):98S-110S. doi: 10.1177/1090198113493910.
Tuberculosis (TB) is a potentially fatal disease spread by an airborne pathogen infecting approximately one third of the globe. For decades, contact tracing (CT) has served a key role in the control of TB and many other notifiable communicable diseases. Unfortunately, CT is a labor-intensive and time-consuming process and is often conducted by a small and overworked nursing staff. To help improve the effectiveness of CT, we introduce a detailed, individual-based model of CT for the Canadian province of Saskatchewan. The model captures the detailed operation of TB CT, including loss to follow-up, and prophylactic and case treatment. This representation is used to assess the impact on active TB cases and TB infection prevalence of differential scoping, speed, prioritization of the CT process, and reduced loss to follow-up. Scenario results are broadly consistent with--but provide many additional insights beyond--our previously reported findings using an aggregate model. In the context of a stylized northern community, findings suggest that age- and ethnicity-prioritized schemes could improve CT effectiveness compared to unprioritized schemes by dramatically reducing TB infection and preventing on average roughly 11% (p < .0001) of active TB cases over a period of 20 years. Reducing loss to follow-up to 10% could yield 5.4% (p = .02) TB cases prevented on average with lower prevalence of TB infection, but improving the CT speed does not yield significant improvement in TB outcomes. Finally, although the work emphasized the value of social network analysis, we found that caution should be exercised in directly translating social network analysis-observed associations into prioritization recommendations.
结核病（TB）是一种潜在致命的疾病，通过空气传播的病原体感染全球约三分之一的人口。几十年来，接触者追踪（CT）在结核病和许多其他法定传染病的控制中发挥了关键作用。不幸的是，CT 是一项劳动密集型且耗时的工作，通常由数量有限且工作量过大的护理人员进行。为了提高 CT 的有效性，我们为加拿大萨斯喀彻温省引入了一个详细的、基于个体的 CT 模型。该模型捕捉了 TB CT 的详细操作，包括失访，以及预防性和病例治疗。这种表示形式用于评估 CT 过程的范围、速度、优先级和减少失访对活动性结核病病例和结核病感染流行率的影响。情景结果与我们之前使用综合模型报告的结果基本一致，但提供了许多额外的见解。在一个模拟的北方社区背景下，研究结果表明，与非优先方案相比，基于年龄和族裔的方案可以通过大大减少结核病感染，平均预防大约 11%（p<0.0001）的活动性结核病病例，从而改善 CT 的有效性在 20 年内。将失访率降低到 10%可以平均预防 5.4%（p=0.02）的结核病病例，同时结核病感染的流行率也会降低，但提高 CT 速度并不能显著改善结核病的结果。最后，尽管这项工作强调了社会网络分析的价值，但我们发现，在直接将社会网络分析观察到的关联转化为优先级建议时，应谨慎行事。
