TB Centre, London School of Hygiene and Tropical Medicine, London, UK
TB Centre, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Glob Health. 2022 Apr;7(4). doi: 10.1136/bmjgh-2021-007136.
There is a high risk of () transmission in healthcare facilities in high burden settings. WHO guidelines on tuberculosis (TB) infection prevention and control (IPC) recommend a range of measures to reduce transmission in healthcare settings. These were evaluated primarily based on evidence for their effects on transmission to healthcare workers in hospitals. To estimate the overall impact of IPC interventions, it is necessary to also consider their impact on community-wide TB incidence and mortality.
We developed an individual-based model of transmission in households, primary healthcare (PHC) clinics, and all other congregate settings. The model was parameterised using data from a high HIV prevalence community in South Africa, including data on social contact by setting, by sex, age, and HIV/antiretroviral therapy status; and data on TB prevalence in clinic attendees and the general population. We estimated the proportion of disease in adults that resulted from transmission in PHC clinics, and the impact of a range of IPC interventions in clinics on community-wide TB.
We estimate that 7.6% (plausible range 3.9%-13.9%) of non-multidrug resistant and multidrug resistant TB in adults resulted directly from transmission in PHC clinics in the community in 2019. The proportion is higher in HIV-positive people, at 9.3% (4.8%-16.8%), compared with 5.3% (2.7%-10.1%) in HIV-negative people. We estimate that IPC interventions could reduce incident TB cases in the community in 2021-2030 by 3.4%-8.0%, and deaths by 3.0%-7.2%.
A non-trivial proportion of TB results from transmission in clinics in the study community, particularly in HIV-positive people. Implementing IPC interventions could lead to moderate reductions in disease burden. We recommend that IPC measures in clinics should be implemented for their benefits to staff and patients, but also for their likely effects on TB incidence and mortality in the surrounding community.
在高负担环境下的医疗机构中，存在着（）传播的高风险。世界卫生组织（WHO）关于结核病（TB）感染预防和控制（IPC）的指南建议采取一系列措施来减少医疗机构中的传播。这些措施主要是根据其对医院医护人员传播的效果进行评估的。为了估计 IPC 干预措施的总体影响，还需要考虑它们对社区范围内 TB 发病率和死亡率的影响。
我们开发了一个基于个体的家庭、初级保健（PHC）诊所和所有其他聚集场所传播模型。该模型使用南非一个高 HIV 流行社区的数据进行参数化，包括按场所、性别、年龄和 HIV/抗逆转录病毒治疗状况划分的社会接触数据；以及诊所就诊者和一般人群中 TB 患病率数据。我们估计了 PHC 诊所中导致成年人疾病的传播比例，以及诊所中一系列 IPC 干预措施对社区范围内 TB 的影响。
我们估计，2019 年，成年人中非耐多药和耐多药结核病的 7.6%（可信区间为 3.9%-13.9%）直接来源于社区 PHC 诊所的传播。在 HIV 阳性人群中，这一比例更高，为 9.3%（4.8%-16.8%），而 HIV 阴性人群为 5.3%（2.7%-10.1%）。我们估计，IPC 干预措施可在 2021-2030 年期间减少社区中新发 TB 病例 3.4%-8.0%，减少死亡 3.0%-7.2%。
在研究社区中，诊所中的传播导致了相当一部分结核病的发生，特别是在 HIV 阳性人群中。实施 IPC 干预措施可能会导致疾病负担的适度减轻。我们建议，应该为了工作人员和患者的利益而在诊所中实施 IPC 措施，还因为这些措施可能对周围社区的 TB 发病率和死亡率产生影响。
