The Aurum Institute, Johannesburg, South Africa
Global Tuberculosis Program, World Health Organisation, Geneva, Switzerland.
BMJ Glob Health. 2020 Jul;5(7). doi: 10.1136/bmjgh-2020-002355.
Tuberculosis (TB) case finding strategies are recommended to increase yield for TB in key populations. Several key populations are identified in the literature, but techniques for estimating yield and prioritising interventions are needed.
We conducted a scoping review of existing evidence on TB burden to assess contribution of key populations to the TB epidemic in South Africa. Reports, articles and conference abstracts from January 2000 to December 2016 were reviewed to determine TB incidence, prevalence and size of key populations in South Africa. Meta-analysis summarised prevalence and incidence rates of TB in selected key populations assessed for heterogeneity. TB risk was calculated for each key population. Number needed to screen (NNS) to diagnose one case of TB disease was computed. Population attributable fraction estimated the potential impact of interventions on TB cases per population.
The search yielded 140 citations, of which 49 were included in the review and a final 32 were included in the meta-analysis. A high prevalence of TB disease was observed in HIV-infected patients with an estimated effect size (ES=0.25, 95% CI 0.20 to 0.30). Heterogeneity was high in this population (=94.8%, p value=0.000). The highest incidence rate of TB disease was observed in the HIV-infected population (ES=6.07, 95% CI 4.90 to 7.51). The risk of TB disease in South Africa was high in informal settlements (RR=5.8), HIV-infected (RR=5.4) and inmates (RR=5.0). Most cases of TB would be found in inmates (NNS=26) and household contacts of patients with TB (NNS=25). A larger impact would be observed if interventions are directed towards inmates (31%), people living with HIV (PLHIV (37%) and informal settlements (43%).
Our findings illustrate the of value using available epidemiological evidence to inform targeted TB interventions. This review suggests that targeting interventions towards inmates, PLHIV and informal settlements would have a bigger impact on TB burden in South Africa.
结核病（TB）病例发现策略被推荐用于增加关键人群的结核病检出率。文献中确定了几个关键人群，但需要评估产量和确定干预措施优先级的技术。
我们对现有的结核病负担证据进行了范围界定审查，以评估关键人群对南非结核病流行的贡献。审查了 2000 年 1 月至 2016 年 12 月的报告、文章和会议摘要，以确定南非的结核病发病率、患病率和关键人群规模。对选定的关键人群进行了荟萃分析，以总结结核病的患病率和发病率，并评估异质性。为每个关键人群计算了筛查以诊断一例结核病的数量（NNS）。人群归因分数估计了针对特定人群的干预措施对结核病病例的潜在影响。
搜索产生了 140 篇引文，其中 49 篇被纳入审查，最后 32 篇被纳入荟萃分析。在感染 HIV 的患者中观察到结核病疾病的高患病率，其效应大小估计值（ES=0.25，95%CI 0.20 至 0.30）。该人群的异质性很高（=94.8%，p 值=0.000）。感染 HIV 的人群中观察到最高的结核病发病率（ES=6.07，95%CI 4.90 至 7.51）。南非非正式住区（RR=5.8）、感染 HIV 的人群（RR=5.4）和囚犯（RR=5.0）的结核病疾病风险较高。在囚犯（NNS=26）和结核病患者的家庭接触者（NNS=25）中会发现更多的结核病病例。如果干预措施针对囚犯（31%）、感染 HIV 的人（PLHIV（37%）和非正式住区（43%），则会观察到更大的影响。
我们的研究结果说明了利用现有流行病学证据为有针对性的结核病干预措施提供信息的价值。这项审查表明，针对囚犯、PLHIV 和非正式住区的干预措施将对南非的结核病负担产生更大的影响。
