在高负担环境中注射药物的人群,基于社区的最佳结核查算法是什么?
Morgana D'Ottavi1, Hong Thi Tran2, Hai Nguyen2
1Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, Institut Nationalde la Santé et de la Recherche Médicale, Montpellier, France.
Open forum infectious diseases
|April 24, 2025
概括
一个新的基于社区的查算法显著改善了越南注射毒品 (PWID) 的人群中的结核病 (TB) 检测. 与当前方法相比,这种优化的方法提高了灵敏度和产量,为这种高风险人群提供了更有效的策略.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 医学诊断 医学诊断 医学诊断
背景情况:
- 注射毒品的人 (PWID) 代表了结核病 (TB) 风险较高的人群.
- 目前的结核病例发现策略不足以确定PWID社区内大多数结核病例.
- 需要改进,基于社区的查算法,以提高这一弱势群体的结核病检测.
研究的目的:
- 开发和评估一个优化的基于社区的查算法,用于在注射毒品的人 (PWID) 中检测结核病.
- 确定具有最高结核病例检测率的最具成本效益的查策略.
- 为了比较不同现场测试组合的性能.
主要方法:
- 使用受访者驱动的抽样方法在越南海招募PWID.
- 查包括结核病症状,C反应性蛋白,带CAD4TB的便携式胸部X射线和唾液Xpert MTB/RIF.
- 通过转诊,确认性测试和外部验证建立了"黄金标准"诊断.
主要成果:
- 在1080名PWID中,47名 (4.4%) 被诊断为结核病患者.
- 使用CAD4TB系统的胸部X射线,其次是Xpert MTB/RIF用于特定的CAD4TB得分,以及有针对性的转诊,将结核病检测灵敏度 (82.9%与43.9%) 和产量 (3.2%与1.7%) 翻了一番.
- 这种增强的算法保持了与标准护理 (309美元) 相比,每例检测到的结核病例 (439美元) 的合理成本.
结论:
- 在越南的PWID中确定了一种有效且价格适度的算法,用于基于社区的结核病查.
- 积极的病例寻找和系统查不应该仅仅依靠基于症状的检测来准确反映结核病患病率.
- 该研究倡导在高风险人群中使用更广泛的查策略,而不仅仅是基于症状的方法.
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