Randera-Rees Safiyya, Clarence Safari Wende, Gareta Dickman, Herbst Kobus, Baisley Kathy, Grant Alison D
Africa Health Research Institute, KwaZulu Natal, South Africa.
National Health Laboratory Services, Johannesburg, 2192, South Africa.
Wellcome Open Res. 2023 Aug 21;6:169. doi: 10.12688/wellcomeopenres.16702.2. eCollection 2021.
HIV-negative men are over-represented in tuberculosis (TB) prevalence surveys including the first South African national TB prevalence survey in 2018. Traditionally, TB screening is focused in clinics. We aimed to determine the frequency of primary healthcare clinic (PHC) attendance among HIV-negative men in a TB-prevalent setting. Since January 2017, PHC attendees in a rural South African demographic surveillance area (DSA) were asked their reason for attendance. HIV status was defined as positive if tested positive in a DSA sero-survey or attended clinic for HIV care; negative if tested negative between January 2014-December 2017 and no HIV-related visits; and HIV-unknown otherwise. Among 67124 DSA residents (≥15 years), 27038 (40.3%) were men; 14196 (21.2%) were classified HIV-positive, 18892 (28.1%) HIV-negative and 34036 (50.7%) HIV-unknown. Between April 2017 and March 2018, 24382/67124 (36.3%, 95% confidence interval [CI] 36.0-36.7) adults made ≥1 PHC visit, comprising 9805/40086 (24.5%, 95%CI 23.6-25.3) of HIV-negative or unknown women and 3440/27038 (12.7%, 95%CI 11.6-13.8) of HIV-negative or unknown men. Overall, HIV care accounted for 37556/88109 (42.6%) of adult PHC visits. In this rural population, HIV-negative and -unknown men rarely attend PHCs. Improving TB screening in clinics may not reach a key population with respect to undiagnosed TB. Additional strategies are needed to diagnose and treat TB earlier.
在包括2018年南非首次全国结核病患病率调查在内的结核病患病率调查中，艾滋病毒阴性男性的占比过高。传统上，结核病筛查集中在诊所进行。我们旨在确定在结核病高发地区艾滋病毒阴性男性到初级卫生保健诊所（PHC）就诊的频率。自2017年1月起，对南非一个农村人口监测区（DSA）的初级卫生保健就诊者询问其就诊原因。如果在DSA血清学调查中检测呈阳性或到诊所接受艾滋病毒治疗，则艾滋病毒状况定义为阳性；如果在2014年1月至2017年12月期间检测呈阴性且无艾滋病毒相关就诊记录，则定义为阴性；否则定义为艾滋病毒状况未知。在67124名DSA居民（≥15岁）中，27038名（40.3%）为男性；14196名（21.2%）被归类为艾滋病毒阳性，18892名（28.1%）为艾滋病毒阴性，34036名（50.7%）艾滋病毒状况未知。在2017年4月至2018年3月期间，24382/67124（36.3%，95%置信区间[CI]36.0 - 36.7）的成年人进行了≥1次初级卫生保健就诊，其中包括9805/40086（24.5%，95%CI 23.6 - 25.3）的艾滋病毒阴性或状况未知的女性以及3440/27038（12.7%，95%CI 11.6 - 13.8）的艾滋病毒阴性或状况未知的男性。总体而言，艾滋病毒治疗占成年人初级卫生保健就诊的37556/88109（42.6%）。在这个农村人口中，艾滋病毒阴性和状况未知的男性很少到初级卫生保健诊所就诊。改善诊所的结核病筛查可能无法覆盖未确诊结核病的关键人群。需要额外的策略来更早地诊断和治疗结核病。
