Chi Fru McWright, Moungui Henri Claude, Musaga Nelson Agweh, Mbatchou-Ngahane Bertrand Hugo
HIV/AIDS and TB treatment units, Foumban Regional Hospital annex, West Region, Cameroon.
Unicaf University of Malawi, Lilongwe, Malawi.
BMC Infect Dis. 2025 Jul 21;25(1):929. doi: 10.1186/s12879-025-11310-w.
A potential contributor to achieving WHO's "End-TB" goal of 90% reduction in TB related mortality by 2030, is scale-up of TB Rapid Diagnostic Testing (RDT). Our study evaluated the contribution of RDTs' in reducing TB-related mortality in both PLHIV and the HIV-negative population, from 2015 to 2023 in Sub-Saharan Africa (SSA).
We carried out an 9-year quantitative retrospective analysis of country-level data (annual WHO TB reports) for all countries in SSA reporting to the WHO. We estimated the following parameters: incidence, notification, percentage of undiagnosed TB patients, percentage diagnosis with RDTs, and TB-related mortality. We stratified the reports according to TB incidence (creating incidence strata) and limited further analysis to reports where the percentage of undiagnosed individuals was 30% or less. We then used scatter plots to examine the existence of a relationship between the use of RDTs and TB-related mortality, and quantified the observed relationships via linear regression models.
Over the nine years, SSA made great strides toward the 2025 milestones of End-TB disease burden-related targets; TB disease incidence decreased by 14%; TB-related mortality decreased by 27.2%; and TB/HIV-related mortality decreased by 64.1%. Similarly, RDT became the priority TB disease diagnostic modality (66.0% in 2023). We found a consistent inverse relationship between RDT scale-up and TB-related mortality in the HIV-negative population, which was significantly stronger in the higher TB incidence settings (R2 = 0.692, P = 0.003). Following adjustments (R = 0.883, P = < 0.001), independent predictors of TB related mortality in this population were TB RDT use, TB incidence, TB notification, percentage undiagnosed TB and percentage with drug resistant TB. In contrast, the relationship was weaker and inconsistent in the PLHIV population and was significant only where the TB incidence among PLHIV was very high (R2 = 0.541, P = 0.0239). Following adjustments (R = 0.944, P < 0.001), just TB incidence and TB treatment coverage in PLHIV were independent predictors of TB mortality in this population.
This study provides support about the anticipated contributions of RDTs in decreasing TB-related mortality in SSA, highlighting the importance of maximum scaleup (addressing underdiagnosis of TB) and limiting the biased prioritization of PLHIV for these RDTs.
扩大结核病快速诊断检测（RDT）的规模是实现世界卫生组织“终止结核病”目标（到2030年将结核病相关死亡率降低90%）的一个潜在因素。我们的研究评估了2015年至2023年期间，RDT在撒哈拉以南非洲（SSA）降低艾滋病毒感染者（PLHIV）和艾滋病毒阴性人群中结核病相关死亡率方面的贡献。
我们对向世界卫生组织报告的SSA所有国家的国家级数据（世界卫生组织年度结核病报告）进行了为期9年的定量回顾性分析。我们估计了以下参数：发病率、通报率、未诊断结核病患者的百分比、使用RDT诊断的百分比以及结核病相关死亡率。我们根据结核病发病率对报告进行分层（创建发病率分层），并将进一步分析限制在未诊断个体百分比为30%或更低的报告中。然后，我们使用散点图来检验RDT的使用与结核病相关死亡率之间是否存在关系，并通过线性回归模型对观察到的关系进行量化。
在这九年中，SSA在实现2025年与结核病疾病负担相关目标的里程碑方面取得了巨大进展；结核病发病率下降了14%；结核病相关死亡率下降了27.2%；结核病/艾滋病毒相关死亡率下降了64.1%。同样，RDT成为结核病疾病诊断的优先方式（2023年为66.0%）。我们发现，在艾滋病毒阴性人群中，RDT规模扩大与结核病相关死亡率之间存在一致的负相关关系，在结核病发病率较高的情况下这种关系显著更强（R2 = 0.692，P = 0.003）。调整后（R = 0.883，P < 0.001），该人群中结核病相关死亡率的独立预测因素是结核病RDT的使用、结核病发病率、结核病通报率、未诊断结核病的百分比以及耐多药结核病的百分比。相比之下，在PLHIV人群中，这种关系较弱且不一致，仅在PLHIV中结核病发病率非常高的情况下才显著（R2 = 0.541，P = 0.0239）。调整后（R = 0.944，P < 0.001），PLHIV中仅结核病发病率和结核病治疗覆盖率是该人群结核病死亡率的独立预测因素。
本研究为RDT在降低SSA结核病相关死亡率方面的预期贡献提供了支持，并强调了最大程度扩大规模（解决结核病诊断不足问题）以及限制对PLHIV使用这些RDT时存在的偏向性优先排序的重要性。
