Jerene Degu, Muleta Chaltu, Dressie Solomon, Ahmed Abdurezak, Tarekegn Getahun, Haile Tewodros, Bedru Ahmed, Mustapha Gidado, Gebhard Agnes, Wares Fraser
KNCV Tuberculosis Foundation, Division of TB Elimination and Health Systems Innovation, The Hague, the Netherlands.
KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia.
J Clin Tuberc Other Mycobact Dis. 2022 Oct 5;29:100333. doi: 10.1016/j.jctube.2022.100333. eCollection 2022 Dec.
Patients with diabetes mellitus (DM) are at increased risk of developing TB, but the best screening algorithm for early detection and treatment of TB remains unknown. Our objective was to determine if combining routine chest X-ray screening could have a better yield compared with symptom-based screening alone.
We conducted this cross-sectional study between September 2020 and September 2021 in 26 public health facilities in Addis Ababa, Ethiopia. All DM patients attending the clinics during the study period were offered chest X-ray and symptom screening simultaneously followed by confirmatory Xpert testing. We analyzed the number and proportion of patients with TB by the diagnostic algorithm category and performed binary logistic regression analysis to identify predictors of TB diagnosis.
Of 7394 patients screened, 54.6 % were female, and their median age was 53 years. Type-2 diabetes accounted for 89.6 % of all participants of the patients. Of 172 symptomatic patients, chest X-ray suggested TB in 19, and 11 of these were confirmed to have TB (8 bacterilogicially confirmed and 3 clinically diagnosed). Only 2 of the 152 asymptomatic patients without X-ray findings had TB (both bacteriologically confirmed). X-ray was not done for one patient. On the other hand, 28 of 7222 symptom-negative patients had X-ray findings suggestive of TB, and 7 of these were subsequently confirmed with TB (6 clinically diagnosed). When combined with 8 patients who were on treatment for TB at the time of the screening, the overall point prevalence of TB was 380 per 100,000. The direct cost associated with the X-ray-based screening was 42-times higher.
Chest X-ray led to detection of about a third of TB patients which otherwise would have been missed but the algorithm is more expensive. Its full cost implication needs further economic evaluation.
糖尿病患者患结核病的风险增加，但早期发现和治疗结核病的最佳筛查算法仍不明确。我们的目的是确定与单纯基于症状的筛查相比，联合常规胸部X线筛查是否能有更高的检出率。
2020年9月至2021年9月，我们在埃塞俄比亚亚的斯亚贝巴的26个公共卫生机构开展了这项横断面研究。在研究期间到诊所就诊的所有糖尿病患者同时接受胸部X线和症状筛查，随后进行Xpert确诊检测。我们按诊断算法类别分析结核病患者的数量和比例，并进行二元逻辑回归分析以确定结核病诊断的预测因素。
在7394名接受筛查的患者中，54.6%为女性，中位年龄为53岁。2型糖尿病占所有患者参与者的89.6%。在172名有症状的患者中，胸部X线提示结核病的有19名，其中11名被确诊为结核病（8名细菌学确诊，3名临床诊断）。152名无X线异常的无症状患者中只有2名患有结核病（均为细菌学确诊）。有1名患者未进行X线检查。另一方面，7222名无症状患者中有28名的X线检查结果提示结核病，其中7名随后被确诊为结核病（6名临床诊断）。加上筛查时正在接受结核病治疗的8名患者，结核病的总现患率为每10万人中有380例。基于X线筛查的直接成本高出42倍。
胸部X线检查可发现约三分之一原本会被漏诊的结核病患者，但该算法成本更高。其全部成本影响需要进一步的经济学评估。
