International Charitable Fund "Alliance for Public Health", Kyiv, Ukraine.
UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland.
J Infect Dev Ctries. 2021 Sep 29;15(9.1):75S-81S. doi: 10.3855/jidc.13806.
In 2018, there were 3 million "missed" tuberculosis (TB) cases globally, much of which was disproportionally concentrated among key populations. To enhance TB case-finding, an Optimized Case Finding (OCF) strategy involving all contacts within the social network of an index TB case was introduced in five regions of Ukraine. We assessed TB detection and linkage to TB treatment using OCF in key populations.
A cohort study using routine program data (July 2018 - March 2020). OCF empowers the index TB case to identify and refer up to eight close contacts within his/her social network for TB investigations.
Of 726 index TB cases in key populations, 6,998 close contacts were referred for TB investigations and 275 were diagnosed with TB (183 drug-sensitive and 92 drug-resistant TB). The TB case detection rate was 3,930/100,000 and the Numbers Needed to Investigate to detect one TB case was 25. TB was most frequent among people who inject drugs and homeless groups. Compared to TB detection using routine household case finding within the general population (1,090/100,000), OCF was 3.6-fold more effective and when compared to passive case finding in the general population (60/100,000), OCF was 66 times more effective. 99% (273) of TB patients were linked to care and initiated TB treatment.
The OCF strategy among key populations is very effective in identifying TB cases and involving them for treatment through the recruitment of the contacts from the risk social networks. We advocate to scale-up this case finding strategy in Ukraine and beyond.
2018 年，全球有 300 万例“漏报”结核病（TB）病例，其中很大一部分不成比例地集中在关键人群中。为了加强结核病病例发现，在乌克兰的五个地区引入了一种优化病例发现（OCF）策略，该策略涉及索引结核病病例的社会网络中的所有接触者。我们使用 OCF 评估了关键人群中的结核病检测和与结核病治疗的联系。
一项使用常规计划数据的队列研究（2018 年 7 月至 2020 年 3 月）。OCF 授权索引结核病病例识别并转介其社交网络中的最多 8 个密切接触者进行结核病调查。
在关键人群中的 726 例索引结核病病例中，转介了 6998 名密切接触者进行结核病调查，其中 275 人被诊断患有结核病（183 例药物敏感和 92 例耐药结核病）。结核病病例检出率为 3930/100000，发现一例结核病所需的调查人数为 25 人。结核病在注射毒品者和无家可归者群体中最为常见。与在普通人群中使用常规家庭发现结核病（1090/100000）相比，OCF 的检出率高 3.6 倍，与普通人群中的被动发现结核病（60/100000）相比，OCF 的检出率高 66 倍。99%（273）的结核病患者得到了护理并开始接受结核病治疗。
在关键人群中实施 OCF 策略在识别结核病病例并通过招募来自风险社会网络的接触者来参与治疗方面非常有效。我们主张在乌克兰及其他地区扩大这种病例发现策略。
