Saavedra Belén, Nguenha Dinis, de la Torre-Pérez Laura, Mambuque Edson, Tembe Gustavo, Oliveras Laura, Rudd Matthew, Philimone Paulo, Jose Benedita, Garcia Juan Ignacio, Gomes Neide, Munguambe Shilzia, Chiconela Helio, Nhanommbe Milton, Izco Santiago, Acacio Sozinho, García-Basteiro Alberto L
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
PLOS Glob Public Health. 2024 Feb 9;4(2):e0002789. doi: 10.1371/journal.pgph.0002789. eCollection 2024.
Prompt diagnosis is critical for tuberculosis (TB) control, as it enables early treatment which in turn, reduces transmission and improves treatment outcomes. We investigated the impact on TB diagnosis of introducing Xpert Ultra as the frontline diagnostic test, combined with an innovative active-case finding (ACF) strategy (based on Xpert Ultra semi-quantitative results and spatial parameters), in a semi-rural district of Southern Mozambique. From January-December 2018 we recruited incident TB-cases (index cases, ICs) and their household contacts (HCs). Recruitment of close community contacts (CCs) depended on IC´s Xpert Ultra results, and the population density of their area. TB-contacts, either symptomatic or people living with HIV, were asked to provide a spot sputum for lab-testing. Trends on TB case notification were compared to the previous years and to those of two districts in the south of the Maputo province (control area), using an interrupted time series analysis with and without control (CITS/ITS). A total of 1010 TB ICs (37.1% laboratory-confirmed) were recruited; 3165 HCs and 4730 CCs were screened for TB. Eighty-nine additional TB cases were identified through the ACF intervention (52.8% laboratory-confirmed). The intervention increased by 8.2% all forms of TB cases detected in 2018. Xpert Ultra trace positive results accounted for a high proportion of laboratory confirmations in the ACF cohort (51.1% vs 13.7% of those passively diagnosed). The Number Needed to Screen to find a TB case differed widely among HCs (55) and CCs (153). During the intervention period, a reversal of the previous negative trend in lab-confirmed case notifications was observed in the district. However, the CITS model did not show any statistically significant difference compared to the control area. Paediatric population benefited the most from the ACF strategy and HCs screening seemed an effective intervention to find microbiological confirmed cases in early stages of the disease.
及时诊断对于结核病防控至关重要，因为它能实现早期治疗，进而减少传播并改善治疗效果。我们在莫桑比克南部的一个半农村地区，研究了引入Xpert Ultra作为一线诊断检测，并结合创新的主动病例发现（ACF）策略（基于Xpert Ultra的半定量结果和空间参数）对结核病诊断的影响。2018年1月至12月，我们招募了新发结核病病例（索引病例，ICs）及其家庭接触者（HCs）。密切社区接触者（CCs）的招募取决于索引病例的Xpert Ultra检测结果及其所在地区的人口密度。有症状的结核病接触者或艾滋病毒感染者被要求提供即时痰标本进行实验室检测。采用有对照和无对照的中断时间序列分析（CITS/ITS），将该地区结核病病例报告趋势与前几年以及马普托省南部两个地区（对照区）的趋势进行比较。共招募了1010例结核病索引病例（37.1%经实验室确诊）；对3165名家庭接触者和4730名密切社区接触者进行了结核病筛查。通过主动病例发现干预又识别出89例结核病病例（52.8%经实验室确诊）。该干预使2018年检测到的各类结核病病例增加了8.2%。在主动病例发现队列中，Xpert Ultra微量阳性结果在实验室确诊中占很高比例（51.1%，而被动诊断的病例中这一比例为13.7%）。筛查出一例结核病病例所需的人数在家庭接触者（55人）和密切社区接触者（153人）中差异很大。在干预期间，该地区观察到之前实验室确诊病例报告的负趋势出现了逆转。然而，与对照区相比，CITS模型未显示出任何统计学上的显著差异。儿科人群从主动病例发现策略中受益最大，对家庭接触者的筛查似乎是在疾病早期发现微生物学确诊病例的有效干预措施。
