Holtgrewe Lydia M L, Johnson Ann, Nyhan Kate, Boffa Jody, Shenoi Sheela V, Karat Aaron S, Davis J Lucian, Charalambous Salome
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.
Yale School of Medicine, New Haven, Connecticut, United States of America.
PLOS Glob Public Health. 2024 Oct 3;4(10):e0003753. doi: 10.1371/journal.pgph.0003753. eCollection 2024.
Identifying case-finding strategies to reduce tuberculosis (TB) incidence in high-burden countries requires better knowledge of the disease burden in key contributing populations and settings. To inform South Africa's National Tuberculosis Strategic Plan 2023-2028, we conducted a systematic review of active TB disease and latent TB infection (LTBI) prevalence and incidence in underserved populations, defined as those living in informal settlements, townships, or impoverished communities. We identified articles published from January 2010 to December 2023, assessed study quality, and conducted a meta-analysis to estimate pooled TB and LTBI prevalence stratified by HIV status. We calculated prevalence ratios for underserved populations compared to the overall South African population. The search yielded 726 unique citations. We identified 22 studies reporting TB prevalence (n = 12), TB incidence (n = 5), LTBI prevalence (n = 5), and/or LTBI incidence (n = 2) eligible for the review, including six high-quality studies. Meta-analysis demonstrated a high prevalence of TB disease among persons living without HIV (2.7% 95% CI 0.1 to 8.5%) and persons living with HIV (PLWH) (22.7%, 95% CI 15.8 to 30.4%), but heterogeneity was high (I2 = 95.5% and 92.3%, p-value<0.00). LTBI prevalence was high among persons living without HIV (44.8%, 95% 42.5 to 47%) with moderate heterogeneity (I2 = 14.6%, p-value = 0.31), and lower among PLWH (33%, 95% CI 22.6 to 44.4%) based on one study. Compared to the national average, underserved populations of persons living without HIV had a 4-fold higher TB prevalence and a 3.3-fold higher LTBI prevalence. Underserved PLWH had a 31-fold higher TB prevalence than the national average, but similar LTBI prevalence as measured in one study. Our findings illustrate that underserved populations in South Africa have a substantially higher TB and LTBI prevalence than the general population, making targeted TB interventions potentially beneficial. More research is needed to explore the heterogeneous TB epidemiology in South Africa.
确定在高负担国家降低结核病（TB）发病率的病例发现策略，需要更好地了解主要相关人群和环境中的疾病负担。为了为南非《2023 - 2028年国家结核病战略计划》提供信息，我们对生活在非正规住区、城镇或贫困社区等服务不足人群中的活动性结核病和潜伏性结核感染（LTBI）患病率及发病率进行了系统综述。我们检索了2010年1月至2023年12月发表的文章，评估了研究质量，并进行了荟萃分析，以估计按HIV状态分层的合并结核病和LTBI患病率。我们计算了服务不足人群与南非总体人群相比的患病率比值。检索共得到726条独特的引文。我们确定了22项报告结核病患病率（n = 12）、结核病发病率（n = 5）、LTBI患病率（n = 5）和/或LTBI发病率（n = 2）且符合综述条件的研究，其中包括6项高质量研究。荟萃分析表明，未感染HIV者（2.7%，95%置信区间0.1%至8.5%）和感染HIV者（PLWH）（22.7%，95%置信区间15.8%至30.4%）中的结核病患病率很高，但异质性也很高（I2分别为95.5%和92.3%，p值<0.00）。未感染HIV者中的LTBI患病率很高（44.8%，95%置信区间42.5%至47%），异质性中等（I2 = 14.6%，p值 = 0.31），而根据一项研究，PLWH中的LTBI患病率较低（33%，95%置信区间22.6%至44.4%）。与全国平均水平相比，未感染HIV的服务不足人群的结核病患病率高出4倍，LTBI患病率高出3.3倍。服务不足的PLWH的结核病患病率比全国平均水平高出31倍，但在一项研究中测量的LTBI患病率与之相似。我们的研究结果表明，南非服务不足人群的结核病和LTBI患病率大大高于一般人群，因此有针对性的结核病干预措施可能有益。需要更多研究来探索南非结核病流行病学的异质性。
