印度HIV感染成人及儿童中症状筛查的有效性及结核病发病率

Effectiveness of symptom screening and incidence of tuberculosis among adults and children living with HIV infection in India.

作者信息

Padmapriyadarsini C, Bhavani P K, Sekar L, Selvaraj M, Poornagangadevi N, Mothi S N, Nandagopal K, Vennila S, Priyadarshini G K, Manisha Mahesh, Sanjeeva G, Agarwal Upasna, Suresh E, Rewari B B, Swaminathan Soumya

机构信息

National Institute for Research in Tuberculosis, No. 1, Sathiyamoorthy Road, Chetput, Chennai 600031, Tamil Nadu, India.

Government Vellore Medical College and Hospital, Vellore, Tamil Nadu, India.

出版信息

Natl Med J India. 2016 Nov-Dec;29(6):321-325.

PMID:28327478

Abstract

BACKGROUND

WHO recommends the use of a simplified symptom-based algorithm for screening for tuberculosis (TB) among people living with HIV (PLHIV). We assessed the feasibility and effectiveness of this algorithm and determined the prevalence and incidence of TB among PLHIV attending antiretroviral treatment (ART) centres in India.

METHODS

We did a prospective multicentric implementation research study in four states of India. To rule out TB, we administered the WHO symptom-screen algorithm to all PLHIV every month for 6 months. If they were found to be symptomatic any time during this period, they were referred for investigations for TB. A case of TB diagnosed during the first month of screening was taken as a prevalent case while those detected TB in the subsequent 5 months were considered cases of incident TB. We calculated the incidence rate using the person-years method. Results . Between May 2012 and October 2013, a total of 6099 adults and 1662 children living with HIV were screened for TB at the ART centres of four states. Of the 6099 adult PLHIV, 1815 (30%) had at least one symptom suggestive of TB, of whom only 634 (35%) were referred for investigations of TB. Of those referred, 97 (15%) PLHIV were diagnosed with TB. Overall, the prevalence of undiagnosed TB was 0.84 person-years and in the subsequent period, the incidence of TB was 2.4/100 person-years (95% CI 1.90-3.10). Among 1662 children, 434 (26%) had at least one symptom suggestive of TB. But only 57 (13%) children were referred for investigations of TB and 13 (23%) of them were diagnosed with TB. The prevalence of TB among children was 0.5% and its incidence among them was 2.7/100 person-years (95% CI 1.60-4.30).

CONCLUSION

Prevalence and incidence of TB is high among PLHIV attending ART centres. This emphasizes the need to strengthen regular screening for symptoms of TB and further referral of those symptomatic for diagnosis of TB.

摘要

背景

世界卫生组织建议使用一种基于症状的简化算法对艾滋病毒感染者（PLHIV）进行结核病筛查。我们评估了该算法的可行性和有效性，并确定了在印度接受抗逆转录病毒治疗（ART）中心治疗的PLHIV中结核病的患病率和发病率。

方法

我们在印度的四个邦进行了一项前瞻性多中心实施研究。为排除结核病，我们对所有PLHIV每月实施世界卫生组织症状筛查算法，持续6个月。如果在此期间的任何时候发现他们有症状，就会被转诊进行结核病检查。筛查第一个月诊断出的结核病病例被视为现患病例，而在随后5个月检测出结核病的病例被视为新发结核病病例。我们使用人年法计算发病率。结果。2012年5月至2013年10月期间，四个邦的ART中心共对6099名成年和1662名儿童艾滋病毒感染者进行了结核病筛查。在6099名成年PLHIV中，1815人（30%）至少有一项提示结核病的症状，其中只有634人（35%）被转诊进行结核病检查。在那些被转诊的人中，97名（15%）PLHIV被诊断为结核病。总体而言，未诊断结核病的患病率为0.84人年，在随后的时期，结核病发病率为2.4/100人年（95%CI 1.90 - 3.10）。在1662名儿童中，434人（26%）至少有一项提示结核病的症状。但只有57名（13%）儿童被转诊进行结核病检查，其中13名（23%）被诊断为结核病。儿童结核病患病率为0.5%，发病率为2.7/100人年（95%CI 1.60 - 4.30）。