Okelloh D, Achola M, Opole J, Ogwang C, Agaya J, Sifuna P, Mchembere W, Cowden J, Heilig M, Borgdorff M W, Yuen C M, Cain K P
Kenya Medical Research Institute, Kisumu, Kenya.
Kenya Medical Research Institute, US Army Medical Research Directorate-Kenya, Kisumu, Kenya.
Public Health Action. 2019 Jun 21;9(2):53-57. doi: 10.5588/pha.18.0085.
Although Kenya has a high burden of tuberculosis (TB), only 46% of cases were diagnosed in 2016.
To identify strategies for increasing attendance at community-based mobile screening units.
We analysed operational data from a cluster-randomised trial, which included community-based mobile screening implemented during February 2015-April 2016. Community health volunteers (CHVs) recruited individuals with symptoms from the community, who were offered testing for human immunodeficiency virus (HIV) and sputum collection for Xpert MTB/RIF testing. We compared attendance across different mobile unit sites using Wilcoxon rank-sum test.
A total of 1424 adults with symptoms were screened at 25 mobile unit sites. The median total attendance among sites was 54 (range 6-134, interquartile range [IQR] 24-84). The median yields of TB diagnoses and new HIV diagnoses were respectively 2.4% (range 0.0-16.7, IQR 0.0-5.3) and 2.5% (range 0.0-33.3, IQR 1.2-4.2). Attendance at urban sites was variable; attendance at rural sites where CHVs were paid a daily minimum wage was significantly higher than at rural sites where CHVs were paid a nominal monthly stipend ( < 0.001).
Mobile units were most effective and efficient when implemented as a single event with community health workers who are paid a daily wage.
尽管肯尼亚结核病负担沉重，但2016年仅有46%的病例得到诊断。
确定提高社区流动筛查单位就诊率的策略。
我们分析了一项整群随机试验的运营数据，该试验包括2015年2月至2016年4月期间实施的社区流动筛查。社区卫生志愿者从社区招募有症状的个体，为其提供人类免疫缺陷病毒（HIV）检测和痰标本采集以进行Xpert MTB/RIF检测。我们使用Wilcoxon秩和检验比较不同流动单位地点的就诊率。
在25个流动单位地点共筛查了1424名有症状的成年人。各地点的总就诊率中位数为54（范围6 - 134，四分位间距[IQR] 24 - 84）。结核病诊断和新HIV诊断的产出率中位数分别为2.4%（范围0.0 - 16.7，IQR 0.0 - 5.3）和2.5%（范围0.0 - 33.3，IQR 1.2 - 4.2）。城市地点的就诊率各不相同；向社区卫生志愿者支付日最低工资的农村地点的就诊率显著高于向社区卫生志愿者支付名义月津贴的农村地点（<0.001）。
当与领取日工资的社区卫生工作者作为单一活动实施时，流动单位最为有效。
