The Desmond Tutu HIV Centre, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Anzio Road, Observatory, Cape Town, 7925, South Africa.
City of Cape Town Health Directorate, Cape Town, South Africa.
Bull World Health Organ. 2017 Aug 1;95(8):554-563. doi: 10.2471/BLT.16.185314. Epub 2017 Apr 28.
To investigate the impact of introducing a rapid test as the first-line diagnostic test for drug-sensitive tuberculosis in Cape Town, South Africa.
Xpert® MTB/RIF (Xpert®), an automated polymerase-chain-reaction-based assay, was rolled out between 2011 and 2013. Data were available on 102 007 adults treated for pulmonary tuberculosis between 2010 and 2014. Tuberculosis notification rates per 100 000 population were calculated for each calendar year and for each year relative to the test roll-out locally, overall and by bacteriological confirmation. Empirical treatment was defined as treatment given without bacteriological confirmation by Xpert®, sputum smear microscopy or sputum culture.
Between 2010 and 2014, the proportion of human immunodeficiency virus (HIV)-negative patients treated empirically for tuberculosis declined from 23% (2445/10 643) to 11% (1149/10 089); in HIV-positive patients, it declined from 42% (4229/9985) to 27% (2364/8823). The overall tuberculosis notification rate decreased by 12% and 19% among HIV-negative and HIV-positive patients, respectively; the rate of bacteriologically confirmed cases increased by 1% and 3%, respectively; and the rate of empirical treatment decreased by 56% and 49%, respectively. These changes occurred gradually following the test's introduction and stabilized after 3 years.
Roll-out of the rapid test in a setting with a high prevalence of pulmonary tuberculosis and HIV infection was associated with a halving of empirical treatment that occurred gradually after the test's introduction, possibly reflecting the time needed for full implementation. More than a quarter of HIV-positive patients with tuberculosis were still treated empirically, highlighting the diagnostic challenge in these patients.
研究在南非开普敦引入快速检测作为药物敏感性肺结核一线诊断检测的影响。
Xpert® MTB/RIF（Xpert®）是一种自动化聚合酶链反应检测方法，于 2011 年至 2013 年期间推出。2010 年至 2014 年期间，有 102007 名成年人因肺结核接受了治疗，在此期间有数据可用。根据当地检测推出的时间，计算了每年每 10 万人的结核病报告率，以及总体和通过 Xpert®、痰涂片显微镜检查或痰培养进行细菌学确认的结核病报告率。经验性治疗定义为未经 Xpert®、痰涂片显微镜检查或痰培养细菌学确认而给予的治疗。
2010 年至 2014 年期间，HIV 阴性患者接受经验性肺结核治疗的比例从 23%（2445/10643）降至 11%（1149/10089）；HIV 阳性患者的比例从 42%（4229/9985）降至 27%（2364/8823）。HIV 阴性和 HIV 阳性患者的结核病总报告率分别下降了 12%和 19%；细菌学确诊病例的比例分别增加了 1%和 3%；经验性治疗的比例分别下降了 56%和 49%。这些变化是在检测推出后逐渐发生的，并在 3 年后趋于稳定。
在肺结核和 HIV 感染流行率高的环境中推出快速检测，与经验性治疗的比例减半有关，这种变化是在检测推出后逐渐发生的，可能反映了全面实施所需的时间。仍有超过四分之一的 HIV 阳性肺结核患者接受经验性治疗，这突显了这些患者的诊断挑战。
