International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
Burnet Institute, Melbourne, Australia.
Int J Infect Dis. 2018 May;70:93-100. doi: 10.1016/j.ijid.2018.02.012. Epub 2018 Feb 21.
We assessed the effect of an active case finding (ACF) project on tuberculosis (TB) case notification and the yields from a household and neigbourhood intervention (screening contacts of historical index TB patients diagnosed >24months ago) and a community intervention (screening attendants of health education sessions/mobile clinics).
Cross-sectional analysis of project records, township TB registers and annual TB reports.
In the household and neigbourhood intervention, of 56,709 people screened, 1,076 were presumptive TB and 74 patients were treated for active TB with a screening yield of 0.1% and a yield from presumptive cases of 6.9%. In the community intervention, of 162,881 people screened, 4,497 were presumptive TB and 984 were treated for active TB with a screening yield of 0.6% and yield from presumptive cases of 21.9%. Of active TB cases, 94% were new, 89% were pulmonary, 44% were bacteriologically-confirmed and 5% had HIV. Case notification rates per 100,000 in project townships increased from 142 during baseline (2011-2013) to 148 during intervention (2014-2016) periods.
The yield from household and neigbourhood intervention was lower than community intervention. This finding highlights reconsidering the strategy of screening of contacts from historical index cases. Strategies to reach high-risk groups should be explored for future ACF interventions to increase yield of TB.
评估主动病例发现（ACF）项目对结核病（TB）病例报告的影响，以及家庭和邻里干预（筛查 24 个月前确诊的历史索引 TB 患者的接触者）和社区干预（筛查健康教育课程/移动诊所的参与者）的效果。
对项目记录、乡镇 TB 登记册和年度 TB 报告进行横断面分析。
在家庭和邻里干预中，对 56709 人进行筛查，发现 1076 人疑似 TB，74 人因活动性 TB 接受治疗，筛查率为 0.1%，疑似病例的检出率为 6.9%。在社区干预中，对 162881 人进行筛查，发现 4497 人疑似 TB，984 人因活动性 TB 接受治疗，筛查率为 0.6%，疑似病例的检出率为 21.9%。活动性 TB 病例中，94%为新发，89%为肺部，44%为细菌学确诊，5%为 HIV 阳性。项目乡镇每 10 万人的病例报告率从基线期（2011-2013 年）的 142 例增加到干预期（2014-2016 年）的 148 例。
家庭和邻里干预的检出率低于社区干预。这一发现提示重新考虑筛查历史索引病例接触者的策略。应探索针对高危人群的策略，以便为未来的 ACF 干预提供更多 TB 病例检出率。
