“普遍检测与治疗”项目使埃塞俄比亚南部古拉格地区一群接受抗逆转录病毒疗法（ART）的成年人中的结核病发病率降低了75%。
"Universal test and treat" program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia.
作者信息
Girum Tadele, Yasin Fedila, Dessu Samuel, Zeleke Bereket, Geremew Mulugeta
机构信息
Department of Public health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
Department of Pharmacy, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
出版信息
Trop Dis Travel Med Vaccines. 2020 Jul 31;6:12. doi: 10.1186/s40794-020-00113-3. eCollection 2020.
BACKGROUND
Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV and at least 25% of deaths are attributed to TB. Many countries implement the Universal Test and Treat (UTT) program for HIV, which is believed to reduce the incidence of TB. However, there are limited studies that evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the "UTT" and "differed treatment" programs, we aim to measure the effect of the UTT program on TB incidence.
OBJECTIVE
To measure the effect of "UTT" program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage Zone, South Ethiopia.
METHODS
A retrospective cohort study was conducted through record review over 5 years (2014-2019) in public health facilities in Gurage Zone. Three hundred eighty-four records were randomly selected and reviewed using a standardized structured checklist. Data was entered using Epi Info™ Version 7 and analyzed by STATA. A generalized linear model with binomial link function was fitted to measure the adjusted incidence density/incidence rate ratio and to identify predictors of incidence difference between the two programs.
RESULTS
During the follow up period, 39 incident TB cases were identified with an overall incidence rate of 4.79/100 person-year (PY). TB incidence was significantly lower in the UTT cohort (IR = 2.10/100 PY) in comparison to the differed program cohort (IR = 6.23/100 PY). The adjusted incidence rate ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI = 0.08-0.70). Thus, there was a reduction of TB incidence by 75% in the UTT program compared to differed program. In addition, IPT (isoniazid preventive therapy) use (AIRR = 0.35 (95% CI = 0.22-0.48)), WHO Stage I and II (AIRR = 0.70 (95% CI = 0.61-0.94)) and higher base line CD4 count (AIRR = 0.96 (95% CI = .94-0.99)) significantly reduced the incidence of TB. However, treatment failure increase the incidence (AIRR = 5.8 (95% CI = 1.93-8.46)).
CONCLUSION
TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.
背景
结核病仍然是艾滋病毒感染者发病和死亡的主要原因，至少25%的死亡归因于结核病。许多国家实施了针对艾滋病毒的普遍检测和治疗（UTT）计划，据信该计划可降低结核病的发病率。然而，评估UTT对结核病发病率影响的研究有限。因此，通过招募“UTT”和“差异治疗”计划中的抗逆转录病毒治疗使用者队列，我们旨在衡量UTT计划对结核病发病率的影响。
目的
衡量“UTT”计划对埃塞俄比亚南部古拉格地区接受抗逆转录病毒治疗（ART）的成年人群中结核病发病率的影响。
方法
通过对古拉格地区公共卫生设施5年（2014 - 2019年）的记录进行回顾，开展了一项回顾性队列研究。随机选择384份记录，并使用标准化结构化清单进行审查。数据使用Epi Info™ 7版本录入，并通过STATA进行分析。采用具有二项式链接函数的广义线性模型来衡量调整后的发病密度/发病率比，并确定两个计划之间发病率差异的预测因素。
结果
在随访期间，共确定了39例结核病发病病例，总体发病率为4.79/100人年（PY）。与差异治疗计划队列（发病率 = 6.23/100 PY）相比，UTT队列中的结核病发病率显著较低（发病率 = 2.10/100 PY）。参与UTT计划的患者中结核病的调整发病率比（AIRR）为0.25（95%置信区间 = 0.08 - 0.70）。因此，与差异治疗计划相比，UTT计划中的结核病发病率降低了75%。此外，使用异烟肼预防性治疗（IPT）（AIRR = 0.35（95%置信区间 = 0.22 - 0.48））、世界卫生组织I期和II期（AIRR = 0.70（95%置信区间 = 0.61 - 0.94））以及较高的基线CD4细胞计数（AIRR = 0.96（95%置信区间 = 0.94 - 0.99））显著降低了结核病的发病率。然而，治疗失败会增加发病率（AIRR = 5.8（95%置信区间 = 1.93 - 8.46））。
结论
UTT实施后，结核病发病率显著降低了75%。因此，进一步降低发病率的干预措施必须侧重于加强UTT计划和IPT。
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