在 COVID-19 大流行之前和期间，艾滋病毒感染者的医院内结核病诊断级联和早期临床结局 - 来自加纳的一项前瞻性多地点队列研究。

The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana.

机构信息

Department of Infectious diseases, Odense University Hospital, Odense, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark; Mycobacterial Centre for Research Southern Denmark MyCRESD, Odense University Hospital, Odense, Denmark; Department of Clinical research, University of Southern Denmark, Odense, Denmark.

Department of Infectious diseases, Odense University Hospital, Odense, Denmark; Mycobacterial Centre for Research Southern Denmark MyCRESD, Odense University Hospital, Odense, Denmark; Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.

出版信息

Int J Infect Dis. 2023 Mar;128:290-300. doi: 10.1016/j.ijid.2022.12.044. Epub 2023 Jan 9.

DOI:10.1016/j.ijid.2022.12.044

PMID:36632893

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9827749/

Abstract

OBJECTIVES

The COVID-19 pandemic had a disruptive impact on tuberculosis (TB) and HIV services. We assessed the in-hospital TB diagnostic care among people with HIV (PWH) overall and before and during the pandemic.

METHODS

In this prospective study, adult PWH admitted at three hospitals in Ghana were recruited if they had a positive World Health Organization four-symptom screen or one or more World Health Organization danger signs or advanced HIV. We collected data on patient characteristics, TB assessment, and clinical outcomes after 8 weeks and used descriptive statistics and survival analysis.

RESULTS

We enrolled 248 PWH with a median clusters of differentiation 4 count of 80.5 cells/mm (interquartile range 24-193). Of those, 246 (99.2%) patients had a positive World Health Organization four-symptom screen. Overall, 112 (45.2%) patients obtained a sputum Xpert result, 66 (46.5%) in the prepandemic and 46 (43.4%) in the pandemic period; P-value = 0.629. The TB prevalence of 46/246 (18.7%) was similar in the prepandemic 28/140 (20.0%) and pandemic 18/106 (17.0%) population; P-value = 0.548. The 8-week all-cause mortality was 62/246 (25.2%), with no difference in cumulative survival when stratifying for the pandemic period; log-rank P-value = 0.412.

CONCLUSION

The study highlighted a large gap in the access to TB investigation and high early mortality among hospitalized PWH, irrespective of the COVID-19 pandemic.

摘要

目的

COVID-19 大流行对结核病（TB）和艾滋病毒服务产生了破坏性影响。我们评估了总体上以及在大流行之前和期间感染艾滋病毒的人（PWH）的住院 TB 诊断护理。

方法

在这项前瞻性研究中，加纳的三家医院收治的成年 PWH 如果他们有阳性的世界卫生组织四项症状筛查或一个或多个世界卫生组织危险标志或晚期艾滋病毒，就会被招募。我们收集了患者特征、TB 评估以及 8 周后临床结局的数据，并使用描述性统计和生存分析。

结果

我们共纳入了 248 名 CD4 计数中位数为 80.5 个细胞/mm（四分位距 24-193）的 PWH。其中，246 名（99.2%）患者的世界卫生组织四项症状筛查呈阳性。总体而言，112 名（45.2%）患者获得了痰 Xpert 结果，66 名（46.5%）在大流行前，46 名（43.4%）在大流行期间；P 值=0.629。大流行前 28/140（20.0%）和大流行期间 18/106（17.0%）人群的 46/246（18.7%）TB 患病率相似；P 值=0.548。8 周全因死亡率为 62/246（25.2%），按大流行期分层时，累积生存率无差异；对数秩检验 P 值=0.412。