全社区普遍的艾滋病毒检测和治疗干预措施减少了乌干达农村的结核病传播:一个集群随机试验
Carina Marquez1, Mucunguzi Atukunda2, Joshua Nugent3
1Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
概括
在乌干达的一项社区研究中,普遍的艾滋病毒检测和治疗显著降低了结核病 (TB) 感染率的27%. 这突显了艾滋病毒治疗之外的更广泛的公共卫生益处.
科学领域:
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
- 艾滋病毒/结核病共感染研究
背景情况:
- 人类免疫缺陷病毒 (HIV) 治疗已知可以降低结核病 (TB) 疾病和死亡率.
- 全民艾滋病毒检测和治疗策略对结核病感染和传播的影响仍然不完全理解.
研究的目的:
- 评估一项普遍的艾滋病毒检测和治疗干预措施对乌干达农村居民发生的结核病感染的影响.
- 评估社区级艾滋病毒干预措施对结核病传播动态的影响.
主要方法:
- 在乌干达的SEARCH社区集群随机试验 (NCT01864603) 中的一项子研究.
- 干预社区每年接受人口水平的艾滋病毒检测和链接;对照社区接受基线和终点检测.
- 结核病感染的发生率是通过5岁及以上个体的结核素皮肤测试转换来确定的,并对参与,感染预测因素和集群进行统计调整.
主要成果:
- 该研究包括9个社区的90,801名参与者 (43,127名干预,47,674名控制).
- 干预组的一年累计结核病感染率为16%,对照组为22%.
- 全民艾滋病毒检测和治疗干预导致发生结核病感染的人口风险降低了27% (调整后风险比率 = 0.73;95% CI: .57-.92,P = .005),在5-11岁儿童和男性中观察到的效果最大.
结论:
- 全民艾滋病毒检测和治疗干预措施有效减少发生的结核病感染,作为减少人口水平结核病传播的关键指标.
- 投资于社区范围的艾滋病毒干预措施可以带来显著的公共卫生效益,包括可证明的结核病发病率的减少.
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