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监狱中结核病通报及治疗结果的趋势:2009年至2014年萨尔瓦多全国范围评估

Trends in tuberculosis notification and treatment outcomes in prisons: a country-wide assessment in El Salvador from 2009-2014.

作者信息

Ayala Gilberto, Garay Julio, Aragon Miguel, Decroo Tom, Zachariah Rony

出版信息

Rev Panam Salud Publica. 2016 Jan;39(1):38-43.

Abstract

Objective To describe trends in tuberculosis (TB) notification and treatment outcomes in 25 prisons in El Salvador from 2009-2014 and to determine if a set of interventions introduced in 2011 affected TB case finding and management. Methods This was operational research that utilized a retrospective cohort study of program data from 2009-2014. The package of interventions introduced in 2011 provides staff training, engages inmates in TB case finding, and offers diagnosis through mobile X-ray and Xpert® MTB/RIF. Results Case notification rates per 100 000 prisoners tripled, from 532 in 2009 to 1 688 in 2014-about 50 times that of the general population. Individual data were analyzed for 1 177 patients who started TB treatment, among whom 1 056 (89.7%) cases were bacteriologically-confirmed: 966 (92%) were diagnosed through smear microscopy; 42 (4%) with Xpert® MTB/RIF; and 48 (5%) through cultures. Cumulative treatment success and cure rates were over 95% and 90%, respectively. However, among 113 patients with previously-treated TB, drug sensitivity testing results were available for only 53 (47.%). One patient was diagnosed with mono-drug resistant TB. Conclusions These findings show that TB notification increased exponentially since introduction of the intervention package and that excellent treatment outcomes were sustained. Both are of vital relevance to countries striving for TB elimination. Notification might be improved further by providing systematic TB screening upon prison entry and periodically thereafter. Furthermore, previously-treated TB patients should receive prioritized screening for drug resistance.

摘要

目的 描述2009年至2014年萨尔瓦多25所监狱结核病(TB)通报情况及治疗结果趋势,并确定2011年实施的一系列干预措施是否影响了结核病病例发现和管理。方法 这是一项运用2009年至2014年项目数据进行回顾性队列研究的操作性研究。2011年实施的一揽子干预措施包括对工作人员进行培训、让囚犯参与结核病病例发现,并通过移动X光和Xpert® MTB/RIF进行诊断。结果 每10万名囚犯的病例通报率增长了两倍,从2009年的532例增至2014年的1688例,约为普通人群的50倍。对1177名开始接受结核病治疗的患者的个体数据进行了分析,其中1056例(89.7%)病例经细菌学确诊:966例(92%)通过涂片显微镜检查确诊;42例(4%)通过Xpert® MTB/RIF确诊;48例(5%)通过培养确诊。累积治疗成功率和治愈率分别超过95%和90%。然而,在113例既往接受过治疗的结核病患者中,仅53例(47%)有药敏试验结果。1例患者被诊断为单耐药结核病。结论 这些结果表明,自实施干预措施以来,结核病通报呈指数级增长,且持续保持了良好的治疗效果。这两者对于努力消除结核病的国家都至关重要。通过在囚犯入狱时及之后定期进行系统性结核病筛查,通报情况可能会进一步改善。此外,既往接受过治疗的结核病患者应优先接受耐药性筛查。

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