Boston University School of Public Health, Boston, MA, USA.
University of Texas at Arlington, Arlington, Texas, USA.
Int J Infect Dis. 2022 Jul;120:125-131. doi: 10.1016/j.ijid.2022.04.031. Epub 2022 Apr 22.
Annually, more than 30% of individuals with tuberculosis (TB) remain undiagnosed. We aimed to assess whether geographic accessibility measures can identify neighborhoods that would benefit from TB screening services targeted toward closing the diagnosis gap.
We used data from a community-based mobile TB screening program in Carabayllo district, Lima, Peru. We constructed four accessibility measures from the geographic center of neighborhoods to health facilities. We used logistic regression to assess the association between these measures and screening uptake in one's residential neighborhood versus elsewhere, with quasi-information criterion values to assess the association.
We analyzed the screening locations for 25,000 Carabayllo residents from 49 neighborhoods. Pedestrian walk time was preferable to Euclidean distance or vehicular time in our models. For each additional 12 minutes walking time between the neighborhood and the health facility, the odds of residents using TB screening units located in their neighborhoods increased by 50% (95% CI: 26%-78%). Females had 9% (95% CI: 3%-16%) increased odds versus males of using a screening unit in their own neighborhood.
Placing mobile TB screening units in neighborhoods with longer pedestrian time to access health facilities could benefit individuals who face more acute access barriers to health care.
每年有超过 30%的结核病（TB）患者未被诊断。我们旨在评估地理可达性措施是否可以识别出那些需要结核病筛查服务的社区，以缩小诊断差距。
我们使用了秘鲁利马 Carabayllo 区基于社区的移动结核病筛查计划的数据。我们从社区中心到医疗机构构建了四个可达性指标。我们使用逻辑回归来评估这些指标与在居住地接受筛查与在其他地方接受筛查之间的关联，并用拟信息准则值来评估关联。
我们分析了来自 49 个社区的 25000 名 Carabayllo 居民的筛查地点。在我们的模型中，步行时间比欧几里得距离或车辆时间更优。如果社区与医疗机构之间的步行时间增加 12 分钟，那么居民在居住地使用结核病筛查单位的可能性增加 50%（95%CI：26%-78%）。与男性相比，女性在自己的社区使用筛查单位的可能性增加 9%（95%CI：3%-16%）。
在步行时间较长才能到达医疗机构的社区设置移动结核病筛查单位，可能会使那些面临更严重医疗保健获取障碍的人受益。
