Bulti Abera Balcha, Dumicho Asnake Yohannes, Shigayeva Altynay, Van Cutsem Gilles, Steele Sarah Jane, Buthelezi M S, Mbatha Mduduzi, Isaakidis Petros, Laxmeshwar Chinmay, Furin Jennifer, Ohler Liesbet
Medical Department, Médecins Sans Frontières, Eshowe, South Africa.
ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Sci Rep. 2025 Apr 23;15(1):14140. doi: 10.1038/s41598-025-90497-z.
Tuberculosis (TB) among hospitalized patients is underdiagnosed. This study assessed systematic TB-screening, followed by an enhanced TB-diagnostic package for hospitalized patients implemented by trained lay health workers in KwaZulu-Natal, South Africa. In this before-and-after study we included patients ≥ 18 years. The intervention consisted of systematic clinical screening for TB, HIV and diabetes mellitus by lay health workers and provision of an enhanced TB-diagnostic package including sputum Xpert MTB/Rif Ultra, urine lateral-flow lipoarabinomannan assay (LF-LAM), chest x-ray, and sputum culture. We compared TB case findings with people hospitalized one year preceding the intervention. In the pre-intervention phase, 5217 people were hospitalized. Among 4913 (94.2%) people not on TB treatment, 367 (7.5%) were diagnosed with TB. In the intervention phase, 4015 eligible people were hospitalized. Among 3734 (93.0%) people not on TB treatment, 560 (15.0%) were diagnosed with TB. The proportion of patients diagnosed with TB was higher in the intervention phase (15.0% vs. 7.5%, p < 0.001). Overall in-hospital mortality was lower in the intervention phase [166/3734(4.5%) vs. 336/4913(6.8%), p < 0.001]. Lay health worker-led implementation of systematic TB-screening, coupled with provision of an enhanced TB-diagnostic package significantly improved TB case detection and mortality among hospitalized adults.
住院患者中的结核病（TB）诊断不足。本研究评估了在南非夸祖鲁 - 纳塔尔由经过培训的非专业卫生工作者为住院患者实施的系统性结核病筛查，随后采用强化结核病诊断套餐。在这项前后对照研究中，我们纳入了年龄≥18岁的患者。干预措施包括由非专业卫生工作者对结核病、艾滋病毒和糖尿病进行系统性临床筛查，并提供强化结核病诊断套餐，包括痰Xpert MTB/Rif Ultra检测、尿液侧向流动脂阿拉伯甘露聚糖检测（LF-LAM）、胸部X光检查和痰培养。我们将结核病病例发现情况与干预前一年住院的患者进行了比较。在干预前阶段，有5217人住院。在4913名（94.2%）未接受结核病治疗的患者中，有367名（7.5%）被诊断为结核病。在干预阶段，有4015名符合条件的患者住院。在3734名（93.0%）未接受结核病治疗的患者中，有560名（15.0%）被诊断为结核病。干预阶段被诊断为结核病的患者比例更高（15.0%对7.5%，p<0.001）。总体而言，干预阶段的住院死亡率较低[166/3734（4.5%）对336/4913（6.8%），p<0.001]。由非专业卫生工作者主导实施系统性结核病筛查，并提供强化结核病诊断套餐，显著提高了住院成年人的结核病病例检出率和降低了死亡率。
