Maokola Werner, Ngowi Bernard, Lawson Lovetti, Mahande Michael, Todd Jim, Msuya Sia E
National AIDS Control Program/Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania.
Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi Urban, Tanzania.
Front Public Health. 2020 Feb 6;7:404. doi: 10.3389/fpubh.2019.00404. eCollection 2019.
People Living with HIV (PLHIV) should be screened for tuberculosis (TB) at every visit to the HIV care and treatment clinic (CTC), and those with positive results on screening should undergo further diagnostic investigations. We evaluated the performance of the TB diagnosis cascade among PLHIV attending CTC between January 2012 and December 2016 in three regions of Tanzania: Dar es Salaam, Iringa, and Njombe. We used descriptive epidemiology to evaluate performance and logistic regression to determine odds ratios (OR) for factors associated with TB screening and further TB diagnosis after positive TB screening. We analyzed 169,741 PLHIV who made 2,638,876 visits to CTC between January 2012 and December 2016. We excluded 2,074 (0.80%) visits as these involved PLHIV enrolled in CTC with a prior TB disease diagnosis. Of the 2,636,802 visits, 2,524,494 (95.67%) had TB screening according to national guidelines, of which 88,028 (3.49%) had TB screening positive results. Of the 88,028 visits with a positive TB screening, 27,810 (31.59%) had no records for further TB diagnosis following positive TB screening. Of all visits with positive TB screening, 32,986 (37.50%) had a TB disease diagnosis. On multivariate logistic regression, those who visited with World Health Organization (WHO) clinical stage four (aOR = 3.61, 95% CI 3.48-3.75, < 0.001), enrolled in health center (aOR = 1.26, 95% CI 1.24-1.29, < 0.001), enrolled in Iringa region (aOR = 1.54, 95% CI 1.50-1.57, < 0.001), and enrolled in 2015 (aOR = 1.20, 95% CI 1.18-1.24, < 0.001) were more likely to have no TB screening. Visits involving those who were of the female sex (aOR = 1.14, 95% CI 1.11-1.18, < 0.001), enrolled in Njombe region (aOR = 4.36, 95% CI 4.09-4.65, < 0.001), and enrolled in 2016 (aOR = 2.62, 95% CI 2.49-2.77, < 0.001) were more likely to have no further TB diagnosis after positive TB screening. The study documented high performance of TB screening for PLHIV in HIV CTCs but a low transition of presumptive TB case undergoing further investigations. Better systems are needed for ensuring presumptive TB cases are diagnosed including using more efficient diagnostic methods like Gene pert.
艾滋病毒感染者（PLHIV）每次前往艾滋病毒护理和治疗诊所（CTC）就诊时都应接受结核病（TB）筛查，筛查结果呈阳性者应接受进一步的诊断检查。我们评估了2012年1月至2016年12月期间在坦桑尼亚三个地区（达累斯萨拉姆、伊林加和琼贝）前往CTC就诊的PLHIV中结核病诊断流程的执行情况。我们使用描述性流行病学来评估执行情况，并使用逻辑回归来确定与结核病筛查以及结核病筛查呈阳性后进一步结核病诊断相关因素的比值比（OR）。我们分析了2012年1月至2016年12月期间前往CTC就诊2,638,876次的169,741名PLHIV。我们排除了2,074次（0.80%）就诊，因为这些就诊涉及在CTC登记且先前已被诊断患有结核病的PLHIV。在这2,636,802次就诊中，根据国家指南，有2,524,494次（95.67%）进行了结核病筛查，其中88,028次（3.49%）结核病筛查结果呈阳性。在88,028次结核病筛查呈阳性的就诊中，有27,810次（31.59%）在结核病筛查呈阳性后没有进一步结核病诊断的记录。在所有结核病筛查呈阳性的就诊中，有32,986次（37.50%）被诊断患有结核病。在多变量逻辑回归分析中，那些以世界卫生组织（WHO）临床分期四就诊的患者（调整后比值比[aOR]=3.61，95%置信区间[CI]3.48 - 3.75，P<0.001）、在卫生中心登记的患者（aOR = 1.26，95% CI 1.24 - 1.29，P<0.001）、在伊林加地区登记的患者（aOR = 1.54，95% CI 1.50 - 1.57，P<0.001）以及在2015年登记的患者（aOR = 1.20，95% CI 1.18 - 1.24，P<0.001）进行结核病筛查的可能性更低。涉及女性患者的就诊（aOR = 1.14，95% CI 1.11 - 1.18，P<0.001）、在琼贝地区登记的患者（aOR = 4.36，95% CI 4.09 - 4.65，P<0.001）以及在2016年登记的患者（aOR = 2.62，95% CI 2.49 - 2.77，P<0.001）在结核病筛查呈阳性后进行进一步结核病诊断的可能性更低。该研究记录了艾滋病毒CTC中对PLHIV进行结核病筛查的高效性，但推定结核病病例接受进一步检查的转化率较低。需要更好的系统来确保推定结核病病例得到诊断，包括使用更有效的诊断方法，如Gene pert。
