Carmone A, Rodriguez C A, Frank T D, Kiromat M, Bongi P W, Kuno R G, Palou T, Franke M F
Clinton Health Access Initiative, Port Moresby, Goroka, Mount Hagen, Papua New Guinea.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Public Health Action. 2017 Sep 21;7(3):193-198. doi: 10.5588/pha.17.0011.
Tuberculosis (TB) is the leading cause of death among people living with the human immunodeficiency virus (PLHIV) in Papua New Guinea. Despite a policy for isoniazid preventive therapy (IPT) among PLHIV, implementation has been slow. We prospectively evaluated a standardized guided screening process, including TB diagnostic support, to increase IPT initiation in adult PLHIV on antiretro-viral treatment. The guided process included a paper-based IPT screening tool that prompted review of patient history and TB symptoms and sputum analysis by smear microscopy and Xpert MTB/RIF. Chest X-ray was performed at the provider's discretion. We quantified the yield of this guided process on IPT initiation and detection of TB and rifampicin resistance, and examined the contributions of each diagnostic modality. Among 532 patients, TB was ruled out and IPT initiated in 450 (84%). TB was diagnosed and treatment was started in 82 (15%) patients. Xpert detected rifampicin resistance in one of 21 patients (5%, 95%CI 0.24-21.3) with a positive Xpert result. All TB cases were diagnosed by chest X-ray and/or Xpert. No cases were diagnosed by sputum smear alone. A standardized guided process, including TB diagnostic support, successfully enabled IPT initiation and identified a large burden of undetected TB.
结核病（TB）是巴布亚新几内亚感染人类免疫缺陷病毒（PLHIV）人群的主要死因。尽管有针对PLHIV进行异烟肼预防性治疗（IPT）的政策，但实施进展缓慢。我们前瞻性评估了一个标准化的引导式筛查流程，包括结核病诊断支持，以提高接受抗逆转录病毒治疗的成年PLHIV开始IPT的比例。该引导式流程包括一个纸质IPT筛查工具，用于促使对患者病史、结核病症状进行回顾，并通过涂片显微镜检查和Xpert MTB/RIF进行痰分析。胸部X光检查由医疗服务提供者酌情进行。我们对该引导式流程在IPT启动以及结核病和利福平耐药性检测方面的产出进行了量化，并研究了每种诊断方式的作用。在532名患者中，450名（84%）排除了结核病并开始了IPT。82名（15%）患者被诊断为结核病并开始治疗。在21名Xpert检测结果呈阳性的患者中，有1名（5%，95%CI 0.24 - 21.3）检测出利福平耐药。所有结核病病例均通过胸部X光检查和/或Xpert诊断。仅通过痰涂片未诊断出任何病例。一个包括结核病诊断支持的标准化引导式流程成功实现了IPT启动，并发现了大量未被检测出的结核病负担。
