Human Sciences Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa; Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
Lancet Infect Dis. 2022 Aug;22(8):1172-1180. doi: 10.1016/S1473-3099(22)00149-9. Epub 2022 May 17.
Tuberculosis remains an important clinical and public health issue in South Africa, which has one of the highest tuberculosis burdens in the world. We aimed to estimate the burden of bacteriologically confirmed pulmonary tuberculosis among people aged 15 years or older in South Africa.
This multistage, cluster-based, cross-sectional survey included eligible residents (age ≥15 years, who had slept in a house for ≥10 nights in the preceding 2 weeks) in 110 clusters nationally (cluster size of 500 people; selected by probability proportional-to-population size sampling). Participants completed face-to-face symptom questionnaires (for cough, weight loss, fever, and night sweats) and manually read digital chest X-ray screening. Screening was recorded as positive if participants had at least one symptom or an abnormal chest X-ray suggestive of tuberculosis, or a combination thereof. Sputum samples from participants who were screen-positive were tested by the Xpert MTB/RIF Ultra assay (first sample) and Mycobacteria Growth Indicator Tube culture (second sample), with optional HIV testing. Participants with a positive Mycobacterium tuberculosis complex culture were considered positive for bacteriologically confirmed pulmonary tuberculosis; when culture was not positive, participants with a positive Xpert MTB/RIF Ultra result with an abnormal chest X-ray suggestive of active tuberculosis and without current or previous tuberculosis were considered positive for bacteriologically confirmed pulmonary tuberculosis.
Between Aug 15, 2017, and July 28, 2019, 68 771 people were enumerated from 110 clusters, with 53 250 eligible to participate in the survey, of whom 35 191 (66·1%) participated. 9066 (25·8%) of 35 191 participants were screen-positive and 234 (0·7%) were identified as having bacteriologically confirmed pulmonary tuberculosis. Overall, the estimated prevalence of bacteriologically confirmed pulmonary tuberculosis was 852 cases (95% CI 679-1026) per 100 000 population; the prevalence was highest in people aged 35-44 years (1107 cases [95% CI 703-1511] per 100 000 population) and those aged 65 years or older (1104 cases [680-1528] per 100 000 population). The estimated prevalence was approximately 1·6 times higher in men than in women (1094 cases [95% CI 835-1352] per 100 000 population vs 675 cases [494-855] per 100 000 population). 135 (57·7%) of 234 participants with tuberculosis screened positive by chest X-ray only, 16 (6·8%) by symptoms only, and 82 (35·9%) by both. 55 (28·8%) of 191 participants with tuberculosis with known HIV status were HIV-positive.
Pulmonary tuberculosis prevalence in this survey was high, especially in men. Despite the ongoing burden of HIV, many participants with tuberculosis in this survey did not have HIV. As more than half of the participants with tuberculosis had an abnormal chest X-ray without symptoms, prioritising chest X-ray screening could substantially increase case finding.
Global Fund, Bill & Melinda Gates Foundation, USAID.
结核病仍然是南非的一个重要临床和公共卫生问题，南非是世界上结核病负担最重的国家之一。我们旨在估计南非 15 岁及以上人群中经细菌学证实的肺结核的负担。
这项多阶段、基于聚类的、横断面调查包括全国 110 个聚类中符合条件的居民（年龄≥15 岁，在过去 2 周内有至少 10 晚在一个房子中睡觉）（聚类大小为 500 人；通过与人口成正比的概率抽样选择）。参与者完成了面对面的症状问卷（咳嗽、体重减轻、发热和盗汗）和手动阅读数字胸部 X 射线筛查。如果参与者有至少一种症状或提示结核病的异常胸部 X 射线，或两者兼有，则将筛查记录为阳性。对筛查阳性的参与者的痰液样本进行 Xpert MTB/RIF Ultra 检测（第一份样本）和分枝杆菌生长指示管培养（第二份样本），并可选地进行 HIV 检测。有阳性结核分枝杆菌复合培养的参与者被认为患有经细菌学证实的肺结核；当培养结果为阴性时，有阳性 Xpert MTB/RIF Ultra 结果、提示活动性肺结核的异常胸部 X 射线且无当前或既往结核病的参与者被认为患有经细菌学证实的肺结核。
2017 年 8 月 15 日至 2019 年 7 月 28 日期间，从 110 个聚类中登记了 68771 人，其中有 110500 人符合参加调查的条件，其中 35191 人（66.1%）参加了调查。9066 名（25.8%）35191 名参与者筛查阳性，234 名（0.7%）被确定患有经细菌学证实的肺结核。总体而言，经细菌学证实的肺结核的估计患病率为每 100000 人中有 852 例（95%CI679-1026）；患病率在 35-44 岁人群中最高（每 100000 人中有 1107 例[95%CI703-1511]），在 65 岁及以上人群中最高（每 100000 人中有 1104 例[680-1528]）。男性的患病率估计是女性的约 1.6 倍（每 100000 人中有 1094 例[95%CI835-1352]，每 100000 人中有 675 例[494-855]）。234 名肺结核患者中有 135 名（57.7%）仅通过胸部 X 射线筛查阳性，16 名（6.8%）仅通过症状筛查阳性，82 名（35.9%）两者均阳性。191 名肺结核患者中有 55 名（28.8%）已知 HIV 状况为阳性。
这项调查中的肺结核患病率很高，尤其是在男性中。尽管 HIV 的负担仍然存在，但该调查中许多患有肺结核的人没有 HIV。由于超过一半的肺结核患者胸部 X 射线异常但无症状，因此优先进行胸部 X 射线筛查可以大大增加病例发现率。
全球基金、比尔及梅琳达·盖茨基金会、美国国际开发署。
