Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco; San Francisco, California, United States of America.
Department of Epidemiology and Biostatistics, University of California, San Francisco; San Francisco, California, United States of America.
PLoS One. 2018 Jul 19;13(7):e0200485. doi: 10.1371/journal.pone.0200485. eCollection 2018.
Contact investigation is an important strategy for maintaining control of tuberculosis (TB) in the United States. However, testing and treatment outcomes specifically to foreign-born populations are poorly understood. We reviewed literature on testing and LTBI identified during contact investigations in foreign-born populations living in the US.
We conducted a comprehensive search of peer-reviewed and grey literature using Cochrane systematic review methods. We included studies with adult and adolescent populations that were at least 50% foreign-born. Pooled proportions and 95% confidence intervals (CIs) were calculated via inverse-variance weighted meta-analysis, and cumulative proportions were calculated as products of adjacent step proportions.
We identified 22 studies published between 1997 and 2014 that included at least 50% foreign-born participants. From studies of predominantly (>90%) foreign-born populations, almost all identified contacts were recruited and had valid test results, and 54.8% (95% CI 45.1-62.5%) of contacts with valid test results tested positive. From studies of majority (50% to 90%) foreign-born populations, 78.4% (95% CI 78.0-78.9%) of identified contacts were recruited, 92.0% (95% CI 91.6-92.3%) of recruited contacts had valid test results, and 38.5% (95% CI 31.9%-44.2%) of persons with valid results tested positive. These proportions varied by test type in studies of predominantly foreign-born populations. For every 1000 contacts identified in predominantly foreign-born populations, we estimate that 535 (95% CI 438 to 625) will test positive, and 354 (95% CI 244 to 453) will complete LTBI treatment. For every 1000 contacts identified in majority foreign-born populations, these estimates are 276 (95% CI 230 to 318), and 134 (95% CI 44 to 264), respectively.
Contact investigation is a high yield activity for identifying and treating foreign-born persons with LTBI, but must be complemented by other tuberculosis control activities in order to achieve continued progress toward TB elimination.
接触者调查是美国维持结核病（TB）控制的重要策略。然而，针对外国出生人群的检测和治疗结果了解甚少。我们回顾了在美国生活的外国出生人群的接触者调查中发现的检测和 LTBI 的文献。
我们使用 Cochrane 系统评价方法对同行评审和灰色文献进行了全面搜索。我们纳入了至少有 50%的外国出生人群的成年和青少年人群的研究。通过逆方差加权荟萃分析计算合并比例和 95%置信区间（CI），并通过相邻步骤比例的乘积计算累积比例。
我们确定了 22 项发表于 1997 年至 2014 年期间的研究，这些研究至少有 50%的外国出生参与者。从主要（>90%）外国出生人群的研究中，几乎所有已识别的接触者都被招募并获得了有效检测结果，并且 54.8%（95%CI 45.1-62.5%）的有有效检测结果的接触者检测呈阳性。从多数（50%至 90%）外国出生人群的研究中，78.4%（95%CI 78.0-78.9%）的已识别接触者被招募，92.0%（95%CI 91.6-92.3%）的已招募接触者有有效的检测结果，并且 38.5%（95%CI 31.9%-44.2%）的具有有效结果的人检测呈阳性。在主要是外国出生人群的研究中，这些比例因检测类型而异。在主要是外国出生人群的研究中，每发现 1000 名接触者，我们估计有 535 名（95%CI 438 至 625 名）将检测呈阳性，有 354 名（95%CI 244 至 453 名）将完成 LTBI 治疗。在外国出生人群占多数的研究中，这些估计值分别为 276（95%CI 230 至 318）和 134（95%CI 44 至 264）。
接触者调查是发现和治疗 LTBI 外国出生人群的一项高收益活动，但必须辅以其他结核病控制活动，以实现消除结核病的持续进展。
