在巴布亚新几内亚，女性性工作者、男男性行为者和变性女性中肺结核的高患病率。
High prevalence of pulmonary tuberculosis among female sex workers, men who have sex with men, and transgender women in Papua New Guinea.
作者信息
Willie Barne, Hakim Avi J, Badman Steven G, Weikum Damian, Narokobi Rebecca, Coy Kelsey, Gabuzzi Josephine, Pekon Simon, Gene Samson, Amos Angelyn, Kupul Martha, Hou Parker, Dala Nick M, Whiley David M, Wapling Johanna, Kaldor John M, Vallely Andrew J, Kelly-Hanku Angela
机构信息
Papua New Guinea Institute of Medical Research, Goroka, 441 EHP, Papua New Guinea.
US Centers for Disease Control and Prevention, Atlanta, USA.
出版信息
Trop Med Health. 2021 Jan 13;49(1):4. doi: 10.1186/s41182-020-00293-w.
BACKGROUND
Papua New Guinea (PNG) has a tuberculosis (TB) case notification rate of 333 cases per 100,000 population in 2016 and is one of the 14 countries classified by the World Health Organization (WHO) as "high-burden" for TB, multi-drug-resistant TB (MDR-TB), and TB/HIV. HIV epidemic is mixed with a higher prevalence among key populations, female sex workers (FSW), men who have sex with men (MSM), and transgender women (TGW).
METHODS
We conducted a cross-sectional HIV biobehavioral survey (BBS) using respondent-driven sampling method among FSW, MSM, and TGW in Port Moresby, Lae, and Mt. Hagen (2016-2017). As part of the study, participants were screened for the four symptoms suggestive of TB infection using the WHO TB screening algorithm. Sputum and venous whole blood samples were collected and tested for pulmonary TB and HIV infection, respectively. Pulmonary TB testing was performed using GeneXpert®MTB/RIF molecular point-of-care test, and HIV testing was done following the PNG national HIV testing algorithm. All data discussed are weighted unless otherwise mentioned.
RESULTS
Among FSW, 72.6%, 52.0%, and 52.9% in Port Moresby, Lae, and Mt. Hagen, respectively, experienced at least one symptom suggestive of TB infection. Among MSM and TGW, 69% and 52.6% in Port Moresby and Lae, respectively, experienced at least one symptom suggestive of TB infection. Based on GeneXpert®MTB/RIF results, the estimated TB prevalence rate among FSW was 1200, 700, and 200 per 100,000 in Port Moresby, Lae, and Mt. Hagen, respectively. Among MSM and TGW, the estimated TB prevalence rate was 1000 and 1200 per 100,000 in Port Moresby and Lae, respectively. Co-prevalence of TB/HIV among FSW was 0.1% in Port Moresby and 0.2% in Lae. There were no co-prevalent cases among FSW in Mt. Hagen or among MSM and TGW in Port Moresby and Lae.
CONCLUSIONS
Key populations have a higher estimated rate of pulmonary TB than the national rate of pulmonary and extra-pulmonary TB combined. This showed that screening key populations for TB should be integrated into HIV programs regardless of HIV status in PNG's national TB response.
背景
2016年，巴布亚新几内亚（PNG）的结核病（TB）病例报告率为每10万人口333例，是世界卫生组织（WHO）列为结核病、耐多药结核病（MDR-TB）和结核病/艾滋病“高负担”的14个国家之一。艾滋病疫情复杂，在关键人群中，女性性工作者（FSW）、男男性行为者（MSM）和变性女性（TGW）的患病率较高。
方法
我们于2016年至2017年期间，在莫尔斯比港、莱城和哈根山的女性性工作者、男男性行为者和变性女性中，采用应答者驱动抽样方法进行了一项横断面艾滋病生物行为调查（BBS）。作为研究的一部分，使用WHO结核病筛查算法对参与者进行四种提示结核病感染症状的筛查。分别采集痰液和静脉全血样本，检测肺结核和艾滋病感染情况。肺结核检测采用GeneXpert®MTB/RIF分子即时检测，艾滋病检测按照PNG国家艾滋病检测算法进行。除非另有说明，所有讨论的数据均为加权数据。
结果
在女性性工作者中，莫尔斯比港、莱城和哈根山分别有72.6%、52.0%和52.9%的人至少出现一种提示结核病感染的症状。在男男性行为者和变性女性中，莫尔斯比港和莱城分别有69%和52.6%的人至少出现一种提示结核病感染的症状。根据GeneXpert®MTB/RIF检测结果，女性性工作者中，莫尔斯比港、莱城和哈根山的估计结核病患病率分别为每10万人1200例、700例和200例。在男男性行为者和变性女性中，莫尔斯比港和莱城的估计结核病患病率分别为每10万人1000例和1200例。女性性工作者中，莫尔斯比港的结核病/艾滋病合并患病率为0.1%，莱城为0.2%。哈根山的女性性工作者以及莫尔斯比港和莱城的男男性行为者和变性女性中均无合并感染病例。
结论
关键人群的估计肺结核患病率高于该国肺结核和肺外结核的合并患病率。这表明，在PNG的国家结核病应对措施中，无论艾滋病感染状况如何，都应将对关键人群的结核病筛查纳入艾滋病项目。
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