Shanaube Kwame, Schaap Ab, Mureithi Linda, Amofa-Sekyi Modupe, Paulsen Robynn, Cheeba Maina, Kangololo Bxyn, Vermaak Redwaan, Sisam Carmen, Kosloff Barry, de Haas Petra, Fidler Sarah, Ruperez Maria, Hayes Richard, Floyd Sian, Ayles Helen
Zambart, Lusaka, Zambia.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLOS Glob Public Health. 2023 Jul 14;3(7):e0001473. doi: 10.1371/journal.pgph.0001473. eCollection 2023.
HPTN071 (PopART) was a cluster randomized trial conducted in Zambian and South African (SA) communities, between 2013-2018. The PopART intervention (universal HIV-testing and treatment (UTT) combined with population-level TB symptom screening) was implemented in 14 communities. The TREATS study (2017-2021) was conducted to evaluate the impact of the PopART intervention on TB outcomes. We report on the impact of the combined TB/HIV intervention on the incidence of TB infection in a cohort of adolescents and young adults (AYA) aged 15-24 years.
A random sample of AYA was enrolled between July 2018 and July 2019 in 7 intervention vs 7 standard-of-care communities. We collected questionnaire data on risk factors for TB, and blood for measuring TB infection using QuantiFERON (QFT) Plus. AYA were seen at months 12 and 24 with all procedures repeated. Primary outcome was incidence of TB infection comparing intervention and standard-of-care communities. An incident case was defined as a participant with QFT interferon-gamma response of < 0.2 IU/ml plasma ('negative') at baseline and a QFT interferon-gamma response of > = 0.7 IU/ml ('positive') at follow up.
We enrolled 4,648 AYA, 2,223 (47.8%) had a negative QFT-plus result at baseline, 1,902 (85.6%) had a follow up blood sample taken at 12 months or 24 months. Among the 1,902 AYA, followed for 2,987 person-years, 213 had incident TB infection giving (7.1 per 100 person-years). TB infection incidence rates were 8.7 per 100 person-years in intervention communities compared to 6.0 per 100 person-years in standard-of-care communities. There was no evidence the intervention reduced the transmission of TB (incidence-rate-ratio of 1.45, 95%CI 0.97-2.15, p = 0.063).
In our trial setting, we found no evidence that UTT combined with TB active case finding reduced the incidence of TB infection at population level. Our data will inform future modelling work to better understand the population level dynamics of HIV and TB.
HPTN071（PopART）是一项于2013年至2018年在赞比亚和南非社区进行的整群随机试验。PopART干预措施（普遍的HIV检测与治疗（UTT）结合人群层面的结核病症状筛查）在14个社区实施。TREATS研究（2017 - 2021年）旨在评估PopART干预措施对结核病结局的影响。我们报告结核病/艾滋病联合干预措施对15至24岁青少年和青年人群（AYA）结核病感染发病率的影响。
2018年7月至2019年7月期间，在7个干预社区和7个标准护理社区随机抽取AYA样本。我们收集了关于结核病危险因素的问卷数据，并采集血液样本使用QuantiFERON（QFT）Plus检测结核病感染情况。在第12个月和第24个月对AYA进行观察，并重复所有程序。主要结局是比较干预社区和标准护理社区的结核病感染发病率。确诊病例定义为基线时QFT干扰素-γ反应<0.2 IU/ml血浆（“阴性”）且随访时QFT干扰素-γ反应>=0.7 IU/ml（“阳性”）的参与者。
我们招募了4648名AYA，其中2223名（47.8%）在基线时QFT-plus检测结果为阴性，1902名（85.6%）在12个月或24个月时采集了随访血样。在这1902名AYA中，随访2987人年，有213人发生结核病感染（每100人年7.1例）。干预社区的结核病感染发病率为每100人年8.7例，而标准护理社区为每100人年6.0例。没有证据表明干预措施降低了结核病的传播（发病率比为1.45，95%CI 0.97 - 2.15，p = 0.063）。
在我们的试验环境中，我们没有发现证据表明UTT联合结核病现患病例发现能在人群层面降低结核病感染发病率。我们的数据将为未来的模型研究提供信息，以更好地理解艾滋病毒和结核病在人群层面的动态变化。
