美国针对性结核病 (TB) 感染检测的使用率低:一项为期15年的连续横截面研究
Jorge R Ledesma1, Yuching Ni1, Jacek Skarbinski2
1Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, 94588, USA.
概括
尽管有指导方针,但加利福尼亚州的结核病感染测试往往错过了来自流行国家的个人. 测试实践经常针对那些没有确定的风险因素的人,这表明推和实际护理之间的差距.
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
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 结核病 (TB) 不成比例地影响到结核病流行国家出生的人,占加利福尼亚州新病例的82%.
- 目前的指导方针主张基于风险因素进行针对性结核病感染 (TBI) 测试,但对测试实践的经验数据仍然很少.
研究的目的:
- 从2008年到2023年,评估TBI测试和干扰素射释放试验 (IGRA) 在北加州凯泽永久医院成年成员中使用的模式.
- 确定与TBI测试和IGRA利用在一个大,多样化的人口中相关的因素.
主要方法:
- 采用了一系列的横截面研究设计,分析了超过650万成年成员的数据.
- 数据收集范围从2008年到2023年,重点关注TBI测试率以及相关的人口和临床风险因素.
- 统计分析包括调整的流行率 (aPR),以评估影响测试和IGRA使用的因素.
主要成果:
- 只有21.4%的成年人接受了TBI测试,78.1%的测试是在缺乏确定的结核病风险因素的个体上进行的.
- 与美国出生的个人相比,出生在结核病流行国家的人患TBI测试的患病率较低25.2%.
- 虽然结核病的密切接触,无家可归和艾滋病毒感染与增加的测试有关,但来自流行国家的个人在测试时更有可能接受IGRA测试.
结论:
- 加利福尼亚州的TBI检测实践与推的指导方针有很大差异,在结核病流行国家出生的高风险人群中,检测不足.
- 目前的方法导致没有明确的风险因素的个体过度测试,并对那些最容易感染结核病的人进行不足的测试.
- 迫切需要将TBI检测策略与基于证据的指导方针协调一致,以改善结核病感染的早期检测和管理.
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