Séri Benjamin, Koffi Ange, Danel Christine, Ouassa Timothée, Blehoué Marcel-Angora, Ouattara Eric, Assemien Jeanne-d'Arc, Masumbuko Jean-Marie, Coffie Patrick, Cartier Nathalie, Laurent Arnaud, Raguin Gilles, Malvy Denis, N'Dri-Yoman Thérèse, Eholié Serge P, Domoua Serge K, Anglaret Xavier, Receveur Marie-Catherine
Programme PAC-CI, ANRS research site, Abidjan, Côte d'Ivoire.
Inserm U1219, University of Bordeaux, Bordeaux, France.
PLoS One. 2017 Jul 31;12(7):e0181995. doi: 10.1371/journal.pone.0181995. eCollection 2017.
In Côte d'Ivoire, a TB prison program has been developed since 1999. This program includes offering TB screening to prisoners who show up with TB symptoms at the infirmary. Our objective was to estimate the prevalence of pulmonary TB among inmates at the Correctional and Detention Facility of Abidjan, the largest prison of Côte d'Ivoire, 16 years after this TB program was implemented.
Between March and September 2015, inmates, were screened for pulmonary TB using systematic direct smear microscopy, culture and chest X-ray. All participants were also proposed HIV testing. TB was defined as either confirmed (positive culture), probable (positive microscopy and/or chest X-ray findings suggestive of TB) or possible (signs or symptoms suggestive of TB, no X-Ray or microbiological evidence). Factors associated with confirmed tuberculosis were analysed using multivariable logistic regression.
Among the 943 inmates screened, 88 (9.3%) met the TB case definition, including 19 (2.0%) with confirmed TB, 40 (4.2%) with probable TB and 29 (3.1%) with possible TB. Of the 19 isolated TB strains, 10 (53%) were TB drug resistant, including 7 (37%) with multi-resistance. Of the 10 patients with TB resistant strain, only one had a past history of TB treatment. HIV prevalence was 3.1% overall, and 9.6%among TB cases. Factors associated with confirmed TB were age ≥30 years (Odds Ratio 3.8; 95% CI 1.1-13.3), prolonged cough (Odds Ratio 3.6; 95% CI 1.3-9.5) and fever (Odds Ratio 2.7; 95% CI 1.0-7.5).
In the country largest prison, pulmonary TB is still 10 (confirmed) to 44 times (confirmed, probable or possible) as frequent as in the Côte d'Ivoire general population, despite a long-time running symptom-based program of TB detection. Decreasing TB prevalence and limiting the risk of MDR may require the implementation of annual in-cell TB screening campaigns that systematically target all prison inmates.
自1999年以来，科特迪瓦已制定了一项监狱结核病防治计划。该计划包括为医务室中出现结核病症状的囚犯提供结核病筛查。我们的目标是在这项结核病计划实施16年后，估算科特迪瓦最大的监狱——阿比让惩教和拘留所中囚犯的肺结核患病率。
2015年3月至9月期间，使用系统直接涂片显微镜检查、培养和胸部X光对囚犯进行肺结核筛查。还建议所有参与者进行艾滋病毒检测。结核病被定义为确诊（培养阳性）、疑似（显微镜检查阳性和/或胸部X光检查结果提示结核病）或可能（有结核病的体征或症状，无X光或微生物学证据）。使用多变量逻辑回归分析与确诊结核病相关的因素。
在接受筛查的943名囚犯中，88人（9.3%）符合结核病病例定义，其中19人（2.0%）确诊为结核病，40人（4.2%）疑似结核病，29人（3.1%）可能患有结核病。在分离出的19株结核菌株中，10株（53%）对结核病药物耐药，其中7株（37%）多重耐药。在10例感染耐药结核菌株的患者中，只有1人有结核病治疗史。艾滋病毒总体患病率为3.1%，结核病病例中为9.6%。与确诊结核病相关的因素包括年龄≥30岁（比值比3.8；95%置信区间1.1-13.3）、长期咳嗽（比值比3.6；95%置信区间1.3-9.5）和发热（比值比2.7；95%置信区间1.0-7.5）。
在该国最大的监狱中，尽管长期实施基于症状的结核病检测计划，但肺结核的发病率仍然是科特迪瓦普通人群的10倍（确诊）至44倍（确诊、疑似或可能）。降低结核病患病率和限制耐多药风险可能需要每年开展针对所有监狱囚犯的狱内结核病筛查活动。
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