Delva Guesly J, Francois Ingrid, Claassen Cassidy W, Dorestan Darwin, Bastien Barbara, Medina-Moreno Sandra, Fort Dumesle St, Redfield Robert R, Buchwald Ulrike K
Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA; Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, USA.
Institute of Human Virology, University of Maryland School of Medicine, 4, Delmas 81, Port-au-Prince, Haiti.
Tuberc Res Treat. 2016;2016:8020745. doi: 10.1155/2016/8020745. Epub 2016 Sep 5.
Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources. Methods. Mache Chache ("Go and Seek") was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance. Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities. Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment.
背景。海地是美洲地区结核病患病率最高的国家,每10万人中有254例病例。病例发现依赖于被动检测,许多地区的结核病服务存在诊断和临床资源匮乏的问题。方法。“Mache Chache”(“去寻找”)是一项由结核病防治加速进展项目(TB REACH)第三阶段资助的结核病病例发现项目,于2013年7月至2014年9月在太子港开展,针对四个结核病诊断表现不足的干预地区。结果。基于强调咳嗽症状的口头症状筛查,该项目在所有筛查人员中确定了11150人(占11.75%)为结核病患者,2.67%为涂片阳性(SS+)结核病病例。加强病例发现和实验室服务导致评估人群中细菌学确诊病例增加了59%。此外,涂片等级显著下降,表明病例发现时间提前。Xpert® MTB/RIF检测方法得以成功引入,并改善了HIV感染的涂片阴性门诊患者的结核病诊断,但在社区中HIV阴性、涂片阴性的结核病疑似患者中未起到同样作用。然而,在门诊和社区筛查活动中,额外筛查出一例SS+病例所需的筛查人数差异很大。结论。在海地加强主动的结核病病例发现可改善结核病的诊断和治疗。然而,筛查算法必须根据具体情况进行调整,这需要长期投入。