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埃博拉对利比里亚结核病病例发现及治疗结果的影响。

Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia.

作者信息

Konwloh P K, Cambell C L, Ade S, Bhat P, Harries A D, Wilkinson E, Cooper C T

机构信息

National Leprosy & Tuberculosis Control Programme, Ministry of Health, Monrovia, Liberia.

International Union Against Tuberculosis and Lung Disease, Paris, France.

出版信息

Public Health Action. 2017 Jun 21;7(Suppl 1):S62-S69. doi: 10.5588/pha.16.0097.

Abstract

National Leprosy and Tuberculosis (TB) Control Programme, Liberia. To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013-March 2014), during (April 2014-June 2015) and after (July-December 2015) the Ebola virus disease outbreak. A cross-sectional study and retrospective cohort analysis of outcomes. The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola ( = 7032, 12%), Ebola ( = 6147, 10%) and post-Ebola ( = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period ( = 855), to the Ebola ( = 640, < 0.001) and post-Ebola ( = 568, < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola ( < 0.001) and 73% post-Ebola ( < 0.001). Loss to follow-up was the main contributing adverse outcome. The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found.

摘要

利比里亚国家麻风病和结核病控制项目。评估埃博拉病毒病疫情之前(2013年1月至2014年3月)、期间(2014年4月至2015年6月)和之后(2015年7月至12月)的结核病病例发现情况,包括与人类免疫缺陷病毒(HIV)相关的干预措施和治疗结果。一项关于结果的横断面研究和回顾性队列分析。推定结核病患者的季度平均人数及诊断为涂片阳性的比例分别为:埃博拉疫情前(n = 7032,12%)、埃博拉疫情期间(n = 6147,10%)和埃博拉疫情后(n = 6795,8%)。对于所有类型的结核病,按类别和年龄组分层,从埃博拉疫情前到埃博拉疫情期间及之后,病例数有不显著的下降。涂片阳性肺结核(PTB)病例数从埃博拉疫情前的时期(n = 855)到埃博拉疫情期间(n = 640,P < 0.001)和埃博拉疫情后(n = 568,P < 0.001)时期有显著下降。接受HIV检测、被发现为HIV阳性并开始接受抗逆转录病毒治疗的患者比例下降如下:埃博拉疫情前(分别为72%、15%和34%)、埃博拉疫情期间(69%、14%和30%)和埃博拉疫情后(68%、12%和26%)。结核病患者的治疗成功率分别为:埃博拉疫情前80%、埃博拉疫情期间69%(P < 0.001)和埃博拉疫情后73%(P < 0.001)。失访是主要的不良结局。埃博拉的主要负面影响是涂片阳性PTB的诊断显著减少、HIV检测和抗逆转录病毒治疗的接受率下降以及治疗成功率低。需要找到在再次发生埃博拉疫情时防止这些不良影响再次出现的方法。

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