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在获得Trace Xpert Ultra检测结果后进行治疗延期以进行评估和监测的患者体验

Patient Experiences of Treatment Deferral for Evaluation and Monitoring after a Trace Xpert Ultra Result.

作者信息

Visek Caitlin, Mukiibi James, Nantale Mariam, Nalutaaya Annet, Biché Patrick, Sung Joowhan, Kayondo Francis, Akampurira Joab, Mukiibi Michael, Kiyonga Rogers, Katamba Achilles, Kendall Emily A

机构信息

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda.

出版信息

medRxiv. 2025 Jan 23:2025.01.22.25320963. doi: 10.1101/2025.01.22.25320963.

Abstract

BACKGROUND

A "trace" result from the Xpert Ultra molecular TB test indicates DNA detection but may not always signify TB disease. Little is known about the experiences of individuals with trace results who are not immediately treated.

METHODS

We enrolled Ugandan adults and adolescents with trace Xpert Ultra sputum results, plus positive and negative controls, from community-screening and clinic settings. After a comprehensive TB evaluation, participants not recommended to start treatment immediately were closely monitored with interval reassessments. Surveys captured participants' perceptions and preferences related to their uncertain TB status at baseline and during follow-up.

RESULTS

A total of 321 people with trace sputum (PWTS), 236 positive controls, and 279 negative controls were enrolled. A minority of PWTS thought they were highly likely to have or develop TB, and most reported low associated anxiety initially (258/321, 80%) and during follow-up. While about half (172/321, 54%) would have favored treatment at baseline if not in the study, those who remained untreated were less inclined toward treatment at six months. Participants generally preferred sensitive diagnostic tests, even with frequent false positives.

CONCLUSIONS

Deferring treatment for PWTS, with sufficient testing and monitoring, is acceptable to most patients.

摘要

背景

Xpert Ultra分子结核检测的“痕量”结果表明检测到了DNA,但这并不总是意味着患有结核病。对于那些检测结果为痕量且未立即接受治疗的个体的经历,我们知之甚少。

方法

我们招募了来自社区筛查和诊所的乌干达成年人及青少年,他们的Xpert Ultra痰液检测结果为痕量,另外还有阳性和阴性对照。在进行全面的结核病评估后,未被建议立即开始治疗的参与者接受了密切监测,并定期重新评估。调查收集了参与者在基线和随访期间对其不确定的结核病状态的看法和偏好。

结果

共招募了321名痰液检测为痕量的人(PWTS)、236名阳性对照和279名阴性对照。少数PWTS认为他们极有可能患有或发展为结核病,大多数人报告最初(258/321,80%)以及随访期间相关焦虑程度较低。虽然如果不在研究中,约一半(172/321,54%)的人在基线时会倾向于接受治疗,但那些未接受治疗的人在六个月时对治疗的倾向较低。参与者通常更喜欢敏感的诊断测试,即使假阳性频繁出现。

结论

对于PWTS,在进行充分检测和监测的情况下推迟治疗,大多数患者是可以接受的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/54b5/12077874/6dc7420feb52/nihpp-2025.01.22.25320963v1-f0001.jpg

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