Haraka Frederick, Glass Tracy R, Sikalengo George, Gamell Anna, Ntamatungiro Alex, Hatz Christoph, Tanner Marcel, Furrer Hansjakob, Battegay Manuel, Letang Emilio
Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania.
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
PLoS One. 2015 Apr 21;10(4):e0123275. doi: 10.1371/journal.pone.0123275. eCollection 2015.
To report on trends of tuberculosis ascertainment among HIV patients in a rural HIV cohort in Tanzania, and assessing the impact of a bundle of services implemented in December 2012, consisting of three components: (i) integration of HIV and tuberculosis services; (ii) GeneXpert for tuberculosis diagnosis; and (iii) electronic data collection.
Retrospective cohort study of patients enrolled in the Kilombero Ulanga Antiretroviral Cohort (KIULARCO), Tanzania.).
HIV patients without prior history of tuberculosis enrolled in the KIULARCO cohort between 2005 and 2013 were included.Cox proportional hazard models were used to estimate rates and predictors of tuberculosis ascertainment.
Of 7114 HIV positive patients enrolled, 5123 (72%) had no history of tuberculosis. Of these, 66% were female, median age was 38 years, median baseline CD4+ cell count was 243 cells/µl, and 43% had WHO clinical stage 3 or 4. During follow-up, 421 incident tuberculosis cases were notified with an estimated incidence of 3.6 per 100 person-years (p-y) [95% confidence interval (CI) 3.26-3.97]. The incidence rate varied over time and increased significantly from 2.96 to 43.98 cases per 100 p-y after the introduction of the bundle of services in December 2012. Four independent predictors of tuberculosis ascertainment were identified:poor clinical condition at baseline (Hazard Ratio (HR) 3.89, 95% CI 2.87-5.28), WHO clinical stage 3 or 4 (HR 2.48, 95% CI 1.88-3.26), being antiretroviralnaïve (HR 2.97, 95% CI 2.25-3.94), and registration in 2013 (HR 6.07, 95% CI 4.39-8.38).
The integration of tuberculosis and HIV services together with comprehensive electronic data collection and use of GeneXpert increased dramatically the ascertainment of tuberculosis in this rural African HIV cohort.
报告坦桑尼亚一个农村艾滋病毒队列中艾滋病毒患者的结核病确诊趋势，并评估2012年12月实施的一系列服务的影响，该系列服务包括三个组成部分：（i）艾滋病毒和结核病服务整合；（ii）采用GeneXpert进行结核病诊断；（iii）电子数据收集。
对坦桑尼亚基洛姆贝罗乌朗加抗逆转录病毒队列（KIULARCO）中登记的患者进行回顾性队列研究。
纳入2005年至2013年期间在KIULARCO队列中登记且无结核病既往史的艾滋病毒患者。采用Cox比例风险模型估计结核病确诊率及预测因素。
在登记的7114名艾滋病毒阳性患者中，5123名（72%）无结核病病史。其中，66%为女性，中位年龄为38岁，基线CD4+细胞计数中位数为243个/µl，43%处于世界卫生组织临床3期或4期。在随访期间，共报告421例新发结核病病例，估计发病率为每100人年3.6例[95%置信区间（CI）3.26 - 3.97]。发病率随时间变化，在2012年12月引入该系列服务后，从每100人年2.96例显著增加至43.98例。确定了结核病确诊的四个独立预测因素：基线时临床状况差（风险比（HR）3.89，95%CI 2.87 - 5.28）、世界卫生组织临床3期或4期（HR 2.48，95%CI 1.88 - 3.26）、未接受过抗逆转录病毒治疗（HR 2.97，95%CI 2.25 - 3.94）以及2013年登记（HR 6.07，95%CI 4.39 - 8.38）。
结核病和艾滋病毒服务的整合，以及全面的电子数据收集和GeneXpert的使用显著提高了这个非洲农村艾滋病毒队列中结核病的确诊率。
