Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City,Viet Nam

• 作者: Luan Nguyen Quang Vo Andrew James Codlin Rachel Jeanette Forse Nga Thuy Nguyen Thanh Nguyen Vu Giang Truong Le Vinh Van Truong Giang Chau Do Ha Minh Dang Lan Huu Nguyen Hoa Binh Nguyen Nhung Viet Nguyen Jens Levy Knut Lonnroth S.Bertel Squire Maxine Caws
• 来源期刊: 贫困所致传染病（英文）
• 年，卷（期）: 2020,（6）
• 所属期刊栏目: RESEARCH ARTICLE
• 页码范围: 16-28
• 页数: 13页
• 语种: 英文

摘要

Background:In order to end tuberculosis(TB),it is necessary to expand coverage of TB care services,including systematic screening initiatives.However,more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health Organization.This study evaluated concurrent screening in multiple target groups using community health workers(CHW). Methods:In our two-year intervention study lasting from October 2017 to September 2019,CHWs in six districts of Ho Chi Minh City,Viet Nam verbally screened three urban priority groups:(1)household TB contacts;(2)close TB contacts;and(3)residents of urban priority areas without clear documented exposure toTB including hotspots,boarding homes and urban slums.Eligible persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF assay.Symptomatic individuals with normal or without radiography results were tested on smear microscopy.We described theTB care cascade and characteristics for each priority group,and calculated yield and number needed to screen.Subsequently,we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment initiation. Results:We verbally screened 321 020 people including 24 232 household contacts,3182 social and close contacts and 293 606 residents of urban priority areas.This resulted in 1138 persons treated forTB,of whom 85 were house-hold contacts,39 were close contacts and 1014 belonged to urban priority area residents.The yield of active TB in these groups was 351,1226 and 345 per 100 000,respectively,corresponding to numbers needed to screen of 285,82 and 290.The fitted model showed that close contacts[adjusted odds ratio(aOR)= 2.07;95％Cl:1.38-3.11;P＜ 0.001]and urban priority area residents(aOR=2.18;95％Cl:1.69-2.79;P＜ 0.001)had a greater risk of active TB than house-hold contacts. Conclusions:The study detected a large number of unreached persons with TB,but most of them were not among persons in contact with an index patient.Therefore,while programs should continue to optimize screening in con-tacts,to close the detection gap in high TB burden settings such as Viet Nam,coverage must be expanded to persons without documented exposure such as residents in hotspots,boarding homes and urban slums.