Visser Hannah, Passey Megan, Walke Emma, Devlin Sue
University Centre for Rural Health, Lismore, NSW Australia.
North Coast Public Health Unit, Lismore, NSW Australia.
Western Pac Surveill Response J. 2019 Dec 17;10(4):24-30. doi: 10.5365/wpsar.2018.9.2.010. eCollection 2019 Oct-Dec.
Ongoing transmission of tuberculosis (TB) continues in Indigenous communities in New South Wales (NSW), Australia. In a pilot project, a Public Health Unit TB team partnered with an Aboriginal Community Controlled Health Service (ACCHS) in a community with a cluster of TB to augment screening for latent TB infection (LTBI) using interferon-gamma release assay (IGRA). This study examined screening data and programme outcomes at 12 months post hoc to advise practice and policy formulation.
We conducted a retrospective, cross-sectional analysis of demographic and clinical data of ACCHS patients, stratified by IGRA testing status. Differences in sex and age distribution between the groups and cases of a genetically and epidemiologically linked TB cluster in Aboriginal people in NSW were assessed using non-parametric tests.
Of 2019 Aboriginal and Torres Strait Islander people seen by general practitioners during the study period, 135 (6.7%) participated in the screening. Twenty-four (17.8%) participants were IGRA positive. One person was diagnosed with active TB. Twelve participants received a chest X-ray at the time of the positive test, and six participants had an additional chest X-ray within 12 months. None commenced preventive treatment for LTBI.
ACCHS screening for LTBI reached individuals in the age group most commonly affected by TB in these Aboriginal communities. No conclusions can be made regarding the population prevalence due to the low screening rate. Further strategies need to be developed to increase appropriate follow-up and preventive treatment.
在澳大利亚新南威尔士州（NSW）的原住民社区中，结核病（TB）仍在持续传播。在一个试点项目中，一个公共卫生部门的结核病团队与一个原住民社区控制卫生服务机构（ACCHS）在一个有结核病聚集病例的社区合作，使用干扰素-γ释放试验（IGRA）加强对潜伏性结核感染（LTBI）的筛查。本研究在事后12个月检查了筛查数据和项目成果，以为实践和政策制定提供建议。
我们对ACCHS患者的人口统计学和临床数据进行了回顾性横断面分析，按IGRA检测状态分层。使用非参数检验评估了两组之间的性别和年龄分布差异以及新南威尔士州原住民中一个基因和流行病学相关的结核病聚集病例情况。
在研究期间，全科医生诊治的2019名原住民和托雷斯海峡岛民中，135人（6.7%）参与了筛查。24名参与者（17.8%）IGRA检测呈阳性。1人被诊断为活动性结核病。12名参与者在检测呈阳性时接受了胸部X光检查，6名参与者在12个月内又进行了一次胸部X光检查。没有人开始接受LTBI预防性治疗。
ACCHS对LTBI的筛查覆盖了这些原住民社区中最常受结核病影响的年龄组人群。由于筛查率低，无法得出关于人群患病率的结论。需要制定进一步的策略来增加适当的后续跟进和预防性治疗。
