Ssemmondo Emmanuel, Mwangwa Florence, Kironde Joel L, Kwarisiima Dalsone, Clark Tamara D, Marquez Carina, Charlebois Edwin D, Petersen Maya L, Kamya Moses R, Havlir Diane V, Chamie Gabriel
*Makerere University-University of California, San Francisco Research Collaboration, Kampala, Uganda; †Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA; ‡Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA; §University of California Berkeley School of Public Health, Berkeley, CA; and ‖Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
J Acquir Immune Defic Syndr. 2016 Nov 1;73(3):e46-e50. doi: 10.1097/QAI.0000000000001142.
Active tuberculosis (TB) screening outside clinics and in communities may reduce undiagnosed TB.
To determine the yield of TB screening during community-based HIV testing campaigns (CHC) in 7 rural Ugandan communities within an ongoing cluster-randomized trial of universal HIV testing and treatment (SEARCH, NCT:01864603), we offered sputum microscopy to participants with prolonged cough (>2 weeks). We determined the number of persons needed to screen to identify one TB case, and the number of cases identified that linked to clinic and completed TB treatment.
Of 36,785 adults enumerated in 7 communities, 27,214 (74%) attended CHCs, and HIV testing uptake was >99%, with 941 (3.5%) HIV-infected adults identified. Five thousand seven hundred eighty-six adults (21%) reported cough and 2876 (11%) reported cough >2 weeks. Staff obtained sputum in 1099/2876 (38%) participants with prolonged cough and identified 10 adults with AFB-positive sputum; 9 new diagnoses and 1 known case already under treatment. The number needed to screen to identify one new TB case was 3024 adults overall: 320 adults with prolonged cough and 80 HIV-infected adults with prolonged cough. All 9 newly diagnosed AFB+ participants were linked to TB care within 2 weeks and were initiated TB treatment.
In a rural Ugandan setting, TB screening as an adjunct to large-scale mobile HIV testing campaigns provides an opportunity to increase TB case detection.
在诊所外和社区开展活动性结核病（TB）筛查可能会减少未被诊断的结核病。
在一项正在进行的关于普遍艾滋病毒检测和治疗的整群随机试验（SEARCH，NCT：01864603）中，为了确定乌干达7个农村社区基于社区的艾滋病毒检测活动（CHC）期间结核病筛查的检出率，我们为咳嗽持续时间延长（>2周）的参与者提供痰涂片显微镜检查。我们确定了筛查出一例结核病病例所需的人数，以及确诊并与诊所建立联系并完成结核病治疗的病例数。
在7个社区登记的36785名成年人中，27214名（74%）参加了社区艾滋病毒检测活动，艾滋病毒检测接受率>99%，确诊941名（3.5%）艾滋病毒感染成年人。5786名成年人（21%）报告有咳嗽，2876名（11%）报告咳嗽>2周。工作人员为1099/2876名（38%）咳嗽持续时间延长的参与者采集了痰液，确诊10名痰涂片抗酸杆菌阳性成年人；9例新诊断病例和1例已知正在接受治疗的病例。总体而言，筛查出一例新结核病病例需要检查3024名成年人：320名咳嗽持续时间延长的成年人和80名咳嗽持续时间延长的艾滋病毒感染成年人。所有9例新诊断的痰涂片抗酸杆菌阳性参与者均在2周内与结核病治疗机构建立联系并开始接受结核病治疗。
在乌干达农村地区，结核病筛查作为大规模流动艾滋病毒检测活动的辅助手段，为增加结核病病例发现提供了机会。
