Walusimbi S, Najjingo I, Zawedde-Muyanja S, Musaazi J, Nyombi A, Katagira W, Ssendiwala J, Muttamba W
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Makerere University Lung Institute, College of Health Sciences, Kampala, Uganda.
Public Health Action. 2022 Jun 21;12(2):90-95. doi: 10.5588/pha.21.0085.
Since 2012, Uganda expanded the Xpert MTB/RIF network for diagnosis of TB.
We compared TB care cascades at health facilities with on-site Xpert vs. facilities that accessed the assay through specimen referral.
We analysed secondary aggregate data of the National TB and Leprosy Program (NTLP) from 2016 to 2019. We computed the proportions of notified TB cases and mortality ratios in relation to the estimated TB burden.
TB case notifications per annum increased from 24,287 in 2016 to 30,739 in 2019, and the proportion of cases diagnosed at facilities with on-site Xpert testing increased from 62% (15,070/24,287) to 81% (24,829/30,739) ( < 0.001). TB mortality at facilities with on-site Xpert decreased from 8.6% (1,302/15,070) to 7.8% (1,938/24,829) ( = 0.41), while it increased at facilities without on-site Xpert from 6.9% (638/9,217) to 8.8% (521/5,910) ( = 0.23). Furthermore, mortality among TB-HIV co-infected patients at facilities with on-site Xpert dropped from 5.0% (760/15,070) in 2016 to 4.8% (1,187/24,826) in 2019 ( = 0.84) compared to 4.4% (407/9,217) in 2016 to 5.3% (315/5,910) in 2019 ( = 0.57).
Wider installation and decentralisation of Xpert leads to increased case-finding. However, the impact on reduction in mortality remains limited. Interventions to address TB-related mortality in addition to Xpert roll-out are required.
自2012年以来，乌干达扩大了用于结核病诊断的Xpert MTB/RIF检测网络。
我们比较了配备现场Xpert检测设备的医疗机构与通过样本送检获取该检测的医疗机构的结核病诊疗流程。
我们分析了2016年至2019年国家结核病和麻风病防治规划（NTLP）的二级汇总数据。我们计算了报告的结核病病例比例以及与估计的结核病负担相关的死亡率。
每年报告的结核病病例从2016年的24287例增加到2019年的30739例，在配备现场Xpert检测的医疗机构中确诊的病例比例从62%（15070/24287）增加到81%（24829/30739）（<0.001）。配备现场Xpert检测的医疗机构的结核病死亡率从8.6%（1302/15070）降至7.8%（1938/24829）（P = 0.41），而在没有现场Xpert检测的医疗机构中死亡率从6.9%（638/9217）升至8.8%（521/5910）（P = 0.23）。此外，配备现场Xpert检测的医疗机构中结核病合并艾滋病毒感染患者的死亡率从2016年的5.0%（760/15070）降至2019年的4.8%（1187/24826）（P = 0.84），相比之下，没有现场Xpert检测的医疗机构中这一比例从2016年的4.4%（407/9217）升至2019年的5.3%（315/5910）（P = 0.57）。
更广泛地安装和分散配置Xpert检测设备可增加病例发现。然而，对降低死亡率的影响仍然有限。除了推广Xpert检测外，还需要采取干预措施来解决与结核病相关的死亡率问题。
