在结核病例发现期间实施先进的艾滋病毒疾病护理套餐,在结核病例发现期间进行临床CD4检测:混合方法评估
Tinne Gils1,2, Mashaete Kamele3, Thandanani Madonsela4
1Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
PloS one
|December 22, 2023
概括
在结核病 (TB) 病例发现的同时实施先进的艾滋病毒疾病 (AHD) 诊断是可行的. 虽然AHD是常见的,但它没有影响生存率,可能是由于测试限制,突出需要改进CD4测试和治疗机会.
科学领域:
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
- 临床诊断 临床诊断 临床诊断 临床诊断
背景情况:
- 结核病 (TB) 和晚期艾滋病毒疾病 (AHD) 经常同时发生,需要综合诊断方法.
- 护理点 (POC) 诊断可以在结核病例发现期间加快AHD识别和管理.
研究的目的:
- 评估在莱索托和南非发现结核病例时实施包括POC诊断在内的AHD护理套餐的可行性.
- 评估这些诊断在艾滋病毒感染者 (PLHIV) 中的可接受性,交付性,流程合规性和早期有效性.
主要方法:
- 一项前性研究,涉及患有结核病症状的成年参与者,提供艾滋病毒检测,Xpert MTB/RIF,MGIT培养,VISITECT CD4,AlereLAM和Immy CrAg测试.
- 通过工作人员问卷,小组讨论,流程合规监测和PLHIV的12周生存分析来评估可行性.
- 用于定性数据的专题内容分析和三角化.
主要成果:
- 在676名PLHIV中,41.7%患有AHD (CD4≤200细胞/μl或阳性结核病测试),20.6%患有结核病诊断.
- VISITECT CD4测试显示,29.9%的PLHIV具有CD4≤200细胞/μl;4.0%的测试PLHIV具有加密球菌抗原阳性.
- 程序对工作人员来说是可以接受的,但交付面临挑战 (供应,长时间:中位数为73分钟). 12周死亡率为AHD的3.3%,非AHDPLHIV的0.9%;AHD和结核病状态与生存无关.
结论:
- 将AHD诊断整合到结核病例发现中是可行的,这表明AHD患病率很高.
- 由于AHD与存活率之间缺乏关联,这表明VISITECT的特异性可能存在问题,并强调需要解决CD4检测和预防性治疗的挑战.
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