2014－2017年南宁市农村地区TB/HIV双重感染患者登记变化趋势分析

目的 分析2014－2017年南宁市农村地区结核分枝杆菌(TB)/艾滋病病毒(HIV)双重感染(简称TB-HIV感染)患者的登记变化趋势,为制定TB-HIV双重感染防控措施提供科学依据。 方法 整理2014－2017年南宁市所有县的TB-HIV双重感染防治工作年度报表数据,统计分析不同年度、不同地区TB-HIV双重感染患者登记、结核病患者筛查HIV和HIV/艾滋病(AIDS)患者筛查TB的报告登记变化情况, 并对登记报告的趋势进行归因和责任分析。 结果 2014－2017年,南宁市农村地区TB-HIV感染患者占结核病患者的比例为5.28％,其中,横县TB-HIV感染患者占结核病患者的比例逐年上升(χ²=24.260, P＜0.001),宾阳县TB-HIV感染患者占结核病患者的比例则逐年下降(χ²=5.518, P＜0.05),各县之间2014－2017年总TB-HIV感染患者占结核病患者的比例差异有统计学意义(χ²=141.132, P＜0.001)。2014-2016年,全市TB-HIV感染患者报告数上升了108.97％,其中,HIV/AIDS患者筛查TB登记报告上升150.79％,结核病患者筛查HIV登记报告下降66.67％;马山县HIV/AIDS患者筛查TB登记报告上升了543.75％,横县HIV/AIDS患者筛查TB登记报告上升了933.33％,宾阳县TB筛查HIV报告上升了300％,而HIV/AIDS患者筛查TB登记报告则下降了66.67％。因马山县和横县的HIV/AIDS患者筛查TB登记造成上升的责任比例分别为102.35%和24.71%,因宾阳县的HIV/AIDS患者筛查TB登记造成下降的责任比例为-11.77%。 结论 2014-2016年南宁市农村地区TB-HIV感染患者登记快速上升,主要由马山县和横县的HIV/AIDS患者筛查TB登记上升引起。应进一步加强和完善结核病和艾滋病综合服务机制,对专业人员进行技能培训,并采用多种筛查和检测方法,更高质量的发现、治疗现有以及潜在的TB-HIV双重感染者,有效控制结核病和艾滋病疫情的蔓延。     

Ending neglect: providing effective childhood tuberculosis training for health care workers in Tanzania

Setting: Health care facilities in Dar es Salaam, Pwani, and Arusha, Tanzania.Objective: To assess health care worker (HCW) knowledge and practices 1 year after specialized training in childhood tuberculosis (TB).Design: Using a standardized survey, we interviewed a convenience sample of HCWs providing both general and specialized care to children.Results: We interviewed 117 HCWs in TB clinics, maternal and child health clinics, human immunodeficiency virus (HIV) clinics, out-patient departments, and pediatric in-patient wards at 12 facilities. A total of 81 HCWs (62% of nurses, 74% of clinicians) reported having attended the national childhood TB training course. Most HCWs responded correctly to questions on childhood TB diagnosis, treatment, and TB-HIV co-management, regardless of training history. Most HCWs reported that they routinely obtain chest radiographs, HIV testing, and a TB contact history when evaluating children for TB. Less than half of HCWs reported routinely obtaining sputum for mycobacterial culture or performing a tuberculin skin test. Three times as many trained as untrained HCWs reported having ever prescribed isoniazid preventive therapy (IPT) to a child (P < 0.05).Conclusion: In general, levels of childhood TB knowledge were high and practices were in accordance with national guidance. Specific gaps in diagnosis, treatment and use of IPT were identified for future focused training.     

Timing and uptake of ART during treatment for active tuberculosis in HIV co-infected adults in Malawi

Setting:

Uptake of antiretroviral therapy (ART) in patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) has historically been low in Malawi. In response, the National TB Programme piloted the initiation of ART 2 weeks after initiation of TB treatment in 2008–2009, a change from the prior policy of 2 months.

Objective:

To determine at programme level if earlier initiation of ART in co-infected patients receiving TB treatment will increase the uptake and continuation of ART.

Design:

A prospective observational pilot programme evaluation using routinely collected monitoring data from the first two sites with integrated TB-HIV services in Malawi.

Results:

There was wide variability in the ART start time before and after the policy change. Before the policy change, 16% of patients initiated ART by 3 months compared to 24% after the policy change (P < 0.001). The proportion of all co-infected patients on ART increased from 32% before the policy change to 39% after (P < 0.001). Earlier initiation of ART did not increase the occurrence of side effects and did not reduce adherence to TB treatment.

Conclusion:

Earlier initiation of ART in co-infected patients receiving TB treatment improved the uptake and continuation of ART. Malawi ART guidelines in 2011 were changed from initiating ART after 2 months to as soon as possible after starting anti-tuberculosis treatment.     

2006～2009年山西省项目县艾滋病合并结核病调查资料分析

[目的]加强对艾滋病合并结核病(TB/HIV双重感染)的认识,提高防治能力。[方法]对山西省5个项目县2006年10月至2009年9月(2006~2009年度)收治的49例TB/HIV双重感染者资料进行分析。[结果]2006~2009年度合计检测3 095例结核病病人,HIV抗体阳性的5例,阳性检出率为0.16%;检测现存活的和新发现的402例AIDS/HIV,检出44例结核病病人,阳性率为10.94%。3个年度5个监测县累积检测TB/HIV双重感染者49例,年平均发病率为2.93/10万,其中稷山县为1.19/10万,绛县为3.27/10万,新绛县为1.24/10万,芮城县为2.60/10万,夏县为6.29/10万,49例均给予正规抗结核治疗,其中31例联合抗艾滋病病毒治疗,坚持抗结核治疗的33例11例治愈,22例完成疗程;死亡7例;正在治疗9例。[结论]TB/HIV双重感染发病率较高,应加强对结核病病人和HIV感染者的检测。     

HIV-TB co-infection in children: associated factors and access to HIV services in Lagos,Nigeria

Background: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children.Methods: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013.Results: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1–4 years and 186 (58.1%) 5–14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05).Conclusion: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.     

Collaborative activities and treatment outcomes in patients with HIV-associated tuberculosis in Viet Nam

Setting: The National Tuberculosis (TB) Programme in Viet Nam and Ho Chi Minh City (HCMC).Objectives: To determine 1) at national level between 2011 and 2013, the relationship between human immunodeficiency virus (HIV) testing, uptake of TB-HIV interventions and adverse treatment outcomes among TB-HIV patients; and 2) in HCMC in 2013, patient characteristics associated with adverse outcomes.Design: An ecological study reviewing aggregate nationwide data and a retrospective cohort review in HCMC.Results: Nationwide, from 2011 to 2013, HIV testing increased in TB patients from 58% to 68% and antiretroviral therapy (ART) increased in TB-HIV patients from 54% to 63%. Adverse treatment outcomes in TB-HIV patients increased from 24% to 27%, largely due to transfer out (5–9% increase) and death. The Northern and Highland regions showed poor uptake of TB-HIV interventions. In HCMC, 303 (27%) of 1110 TB-HIV patients had adverse outcomes, with higher risks observed in those with previously treated TB, those diagnosed as HIV-positive before TB onset and those never placed on cotrimoxazole or ART.Conclusion: Despite improving HIV testing rates and TB-HIV interventions, adverse outcomes in TB-HIV patients remain at about 26%. Characteristics predicting higher risk of adverse outcomes must be addressed if Viet Nam wishes to end the TB epidemic by 2030.     

The effect of energy-protein supplementation on weight, body composition and handgrip strength among pulmonary tuberculosis HIV-co-infected patients: randomised controlled trial in Mwanza, Tanzania

Undernutrition is common among smear-positive pulmonary tuberculosis (PTB+) patients. Micronutrient supplementation may improve treatment outcomes, but it is unclear whether additional energy-protein would be beneficial. The present study aimed to assess the effect of energy-protein supplementation on weight, body composition and handgrip strength against a background of high micronutrient intake during tuberculosis (TB) treatment. A total of 377 PTB+ patients co-infected with HIV were randomly allocated one or six biscuits daily for 60?d during TB treatment. Weight, arm fat area, arm muscle area and handgrip strength were assessed at baseline and 2 and 5 months. There were no effects on any outcome at 2 months, but energy-protein supplementation was associated with a 1·3 (95?% CI -?0·1, 2·8)?kg marginally significant gain in handgrip strength at 5 months. However, after 2 months, energy-protein supplementation led to a weight gain of 1·9 (95?% CI 0·1, 3·7)?kg among patients with cluster of differentiation 4 (CD4) counts ≥?350?cells/μl, but not among patients with low CD4 counts (?-?0·2?kg; 95?% CI -?1·3, 0·8, Pinteraction?=?0·03). Similarly, at 5 months, energy-protein supplementation led to a 2·3 (95?% CI 0·6, 4·1)?kg higher handgrip strength gain among patients with CD4 counts 相似文献   

Anti-tuberculosis drug resistance patterns and trends in a tuberculosis referral hospital, 1997-2009

Information about the changing epidemiology of drug-resistant tuberculosis (TB) in hospitals in China over the past decade remains largely unknown. This study examined the susceptibility patterns and trends of drug-resistant TB cases in the 309 Hospital in Beijing, China. Mycobacterium tuberculosis isolates were retrospectively identified, drug susceptibility test (DST) results and clinical data were analysed for the period 1997-2009. Of the 5523 culture-positive TB patients, 47·1% had resistance to any anti-TB drug, 14·8% had mono-resistant TB, 19·8% had poly-resistant TB, 19·4% had multidrug-resistant TB (MDR-TB), and 1·3% had extensively drug-resistant TB (XDR-TB). Drug-resistant TB was significantly associated with age group, residential situation, and TB treatment history (P<0·001). During 1997-2000, the percentage of TB patients with any resistance, mono-resistant TB, poly-resistant TB, MDR-TB and XDR-TB all increased significantly (P<0·001). During 2000-2003, the increasing trends of MDR-TB and XDR-TB cases were reversed. During 2004-2009, the percentage of TB patients with any resistance, mono-resistant TB, poly-resistant TB, MDR-TB and XDR-TB all declined significantly (P<0·001), but the prevalence of MDR-TB and poly-resistant TB cases remained high. Our study provides evidence demonstrating that intensive TB control measures have helped reverse the increasing trends of drug-resistant TB in China, but continuous surveillance of drug-resistant TB and better case management are still needed to further reduce the remaining high prevalence of drug-resistant TB.     

Antiretroviral treatment among co-infected tuberculosis patients in integrated and non-integrated facilities

Background: South Africa has the second worst tuberculosis-human immunodeficiency virus (TB-HIV) syndemic in the world: in 2011, the TB-HIV co-infection rate was estimated at 65%. Integration of TB and HIV health-care services was implemented to increase antiretroviral treatment (ART) uptake among eligible patients.Aim: To evaluate whether integrated TB and HIV facilities had better ART uptake among eligible patients compared to non-integrated facilities.Methods: A cross-sectional study using routine TB programme data from January to December 2010. ART eligibility was defined as a CD4+ cell count <350 cells/μl.Results: Respectively 2761 (86.8%) and 3611 (84.7%) patients were eligible for ART at integrated and non-integrated facilities (P < 0.001). The proportion of patients started on ART at integrated facilities did not differ significantly from that of non-integrated facilities (35.9% vs. 37.1%, P = 0.340), but the proportion with unknown HIV status (31.8% vs. 24.5%, P < 0.001) and unknown CD4+ cell count (40.9% vs. 30.4%, P < 0.001) did.Conclusion: Integration of TB and HIV services in the Free State (2009–2010) was not associated with improved ART uptake. The reasons why are not clear. Of concern are the high proportions of unknown HIV status and CD4+ cell count results, especially at integrated facilities, and the small proportion of patients on ART, which may indicate poor implementation of integration.     

Prevalence of tuberculin skin test positivity and conversions among healthcare workers in New York City during 1994 to 2001.

OBJECTIVE: To determine the prevalence of and risk factors for tuberculin skin test positivity and conversion among New York City Department of Health and Mental Hygiene employees. DESIGN: Point-prevalence survey and prospective cohort analysis. Sentinel surveillance was conducted from March 1, 1994, to December 31, 2001. PARTICIPANTS: HCWs in high-risk and low-risk settings for occupational TB exposure. RESULTS: Baseline tuberculin positivity was 36.2% (600 of 1,658), 15.5% (143 of 922) among HCWs born in the United States, and 48.5% (182 of 375) among HCWs not born in the United States. There were 36 tuberculin conversions during 2,754 observation-years (rate, 1.3 per 100 person-years). For HCWs born in the United States, the risk for tuberculin conversion was greater in high-risk occupational settings compared with low-risk settings (OR, 5.7; CI95, 1.7-19.2; P < .01). HCWs not born in the United States and those employed at the Office of the Chief Medical Examiner (OCME) were at high risk for baseline tuberculin positivity (OR, 3.2; CI95, 1.7-5.8; P < .001); OCME HCWs (OR, 4.7; CI95, 2.3-9.4; P < .001), those of Asian ethnicity (OR, 4.3; CI95, 1.4-13.5; P < .01), and older HCWs (OR, 1.0; CI95, 1.0-1.1; P < .05) were at a higher risk for conversion. CONCLUSIONS: Although the prevalence of tuberculin positivity decreased after the peak of the recent TB epidemic in New York City, the conversion rate among HCWs in high-risk occupational settings for TB exposure was still greater than that among HCWs in low-risk settings. Continued surveillance of occupational TB infection is needed, especially among high-risk HCWs.     

An audit of rubella IgG antibody status in antenatal women in a NHS Trust over 5 years (2005-2009)

Rubella, a vaccine-preventable infection. This study examined the antibody status of 11 987 pregnant women during 2005-2009. Results showed a non-significant decrease in those with antibody levels of <4·0 IU/ml from 29/2312 (1·3%) in 2005 to 21/2447 (0·9%) in 2009 (χ2 for linear trend=0·279, P=0·56) but a significant increase in those with levels of <10 IU/ml from 88/2312 (3·8%) in 2005 to 124/2447 (5·1%) in 2009 (χ2 for linear trend=10·27, P=0·001). In women born before 1983 (pre-pubertal vaccination) the proportion of first pregnancies with titres <4 IU was 1·1% (21/2002) compared to 3·4% (69/2022) in those born after 1983 (χ2=25·176, P<0·0001) and 2·2% (44/2002) for titres <10 IU compared to 14·0% (282/2022) for those born after 1983 (χ2=171·43, P<0·0001). The potential impact of the increase is difficult to determine, requiring further monitoring. This paper discusses the effect of changing immunization programmes on rubella susceptibility in pregnant women.     

山东省结核病人中HIV感染率调查资料的流行病学特征分析

[目的]了解山东省结核病人中的HIV感染率基线情况并着重对不同性别TB/HIV感染者的流行病学特征进行分析,为降低HIV感染人群中结核病的负担提供基础数据。[方法]采用系统抽样方法抽取14个县作为调查点,对调查点2007年9月1日至12月31日期间新登记的结核病人进行HIV抗体筛检工作。[结果]项目期间共纳入有效病人1881例,进行HIV抗体初筛1794例,受检率为95.37% 检测出TB/HIV双重感染者2例,检出率为1.11‰ 不同性别结核病人的年龄、学历、婚姻状况分布不同 检出的2例TB/HIV双重感染者具备主动实施的高危行为史。[结论]山东省结核病人中的HIV感染率较低 在HIV低流行地区的结核病人中开展常规HIV抗体的普遍筛检不符合成本效益原则 对具有高危行为的结核病人进行选择性HIV抗体检测尤为重要。     

Integrating tuberculosis and HIV services in rural Kenya: uptake and outcomes

Setting: Seventeen rural public health facilities in Western Kenya that introduced three models of integrated care for tuberculosis (TB) and human immunodeficiency virus (HIV) patients.Objective: To assess the uptake and timing of cotrimoxazole preventive therapy (CPT) and antiretroviral treatment (ART) as well as anti-tuberculosis treatment outcomes among HIV-infected TB patients before (March–October 2010) and after (March–October 2012) the introduction of integrated TB-HIV care.Design: A before-and-after cohort study using programme data.Results: Of 501 HIV-infected TB patients, 357 (71%) were initiated on CPT and 178 (39%) on ART in the period before the introduction of integrated TB-HIV care. Following the integration of services, respectively 316 (98%) and 196 (61%) of 323 HIV-infected individuals were initiated on CPT and on ART (P < 0.001). The median time to CPT and ART initiation dropped from 7 to 2 days and from 42 to 34 days during the pre- and post-integration phases, respectively. Overall TB success rates did not vary with integration or with type of model instituted.Conclusion: Integration of TB and HIV services enhanced uptake and reduced delay in instituting CPT and ART in rural health facilities. There is a need to increase impetus in these efforts.     

Sputum smear conversion during intensive TB treatment phase according to HIV status, in hospitalised patients in Togo

Method

We prospectively studied patients with pulmonary TB, with or without HIV-1 co-infection, from December 1, 2007 to December 1, 2008. Two groups of patients naive for TB and antiretroviral treatment (group A: 96 co-infected TB/HIV and group B: 171 TB infected but HIV negative) were selected randomly. The CD4 count was assessed according to HIV status, and all patients received RHEZ TB treatment for 2 months. Pulmonary smear was assessed at two weeks, four weeks, six weeks, and eight weeks.

Result

Two hundred and sixty seven patients were treated (26.6% of admissions). The mean age was 34.62 ± 11 years and the sex ratio was 1.3. A proportion of 35.75% patients were HIV co-infected with a median CD4 count at 157 cells per millimeter cube. The sputum smear conversion was obtained for more than 87.5% of patients in group A and 24.56% in group B at two weeks; 94% of patients in group A and 61.83% in group B at four weeks; 100% of patients in group A and 87.33% in group B at six weeks, and 100% of patients in group A and 96.77% in group B at eight weeks. P < 0.05 at six weeks.

Conclusion

HIV infected TB patients were more susceptible to treatment than TB/HIV infected patients in the first six weeks.     

Tuberculosis in health care workers in Malawi.

Although sub-Saharan Africa has the highest rates of tuberculosis (TB) and human immunodeficiency virus (HIV) infection in the world, the rates of TB amongst its health care workers (HCWs) are poorly documented. We therefore conducted a country-wide investigation. All district/government and mission hospitals in Malawi that diagnose and care for TB patients were visited in order to obtain information on hospital-based HCWs and their incidence of TB in 1996. Hospital TB case loads, country-wide TB notification numbers and national population estimates for 1996 were obtained, which enabled TB case notification rates to be calculated. In 1996, 108 (3.6%) of 3042 HCWs from 40 hospitals were registered and treated for TB: 22 with smear-positive pulmonary TB (PTB), 40 with smear-negative PTB and 46 with extrapulmonary TB. The overall case fatality rate was 24%. Compared with the adult general population aged > or = 15 years, the relative risk [95% confidence interval (CI)] in HCWs of all types of TB was 11.9 [9.8-14.4], of smear-positive PTB 5.9 [3.9-9.0], of smear-negative PTB 13.0 [9.5-17.7] and of extrapulmonary TB 18.4 [13.8-24.6], P < 0.05. The 1996 hospital TB case load ranged from 29 to 915: there were no cases of TB in HCWs in hospitals whose case load was < or = 100 patients, while the TB case rate among HCWs was similar in hospitals with annual case loads of 101-300 or > 300. The annual risk of TB was high among all categories of HCW, especially clinical officers. This study shows a high rate of TB in HCWs in Malawi, and emphasizes the need for practical and affordable control measures for the protection of HCWs from TB in low-income countries.     

Utility of dual skin tests to evaluate tuberculin skin test reactions of 10 to 14 mm in healthcare workers.

OBJECTIVE: To define the utility of 10- to 14-mm reactions to a Mycobacterium tuberculosis purified protein derivative (PPD) skin test for healthcare workers (HCWs). DESIGN: Blinded dual skin testing, using PPD and M. avium sensitin, of HCWs at a single medical center who had a 10- to 14-mm reaction to PPD when tested by personnel from the Occupational Health Department as part of routine annual screening. SETTING: A single tertiary-care academic medical center. PARTICIPANTS: Employees of the medical center who underwent routine annual PPD screening and were identified by the Occupational Health Department as having a reaction of 10 to 14 mm to PPD. RESULTS: Nineteen employees were identified as candidates and 11 underwent dual skin testing. Only 4 (36%) had repeat results for PPD in the 10- to 14-mm range, whether read by Occupational Health Department personnel or study investigators. For only 5 (45%) of the subjects did the Occupational Health Department personnel and study investigators concur (+/- 3 mm) on the size of the PPD reaction. Two of the 4 subjects with reactions of 10 to 14 mm as measured by the study investigators were M. avium sensitin dominant, 1 was PPD dominant, and 1 was nondominant. CONCLUSION: A reaction of 10 to 14 mm to PPD should not be used as an indication for the treatment of latent tuberculosis (TB) infection in healthy HCWs born in the United States with no known exposure to TB.     

A trend analysis and sub-regional distribution in number of people living with HIV and dying with TB in Africa, 1991 to 2006

Background  

The tuberculosis (TB) bacillus and the Human Immunodeficiency Virus (HIV) have formed a powerful alliance and are together responsible for more than five million deaths per year. TB is leading to increased mortality rates among people living with HIV/acquired immunodeficiency syndrome (AIDS). The aim of this study was to investigate the geographical and temporal distribution of TB-HIV deaths in Africa in order to identify possible high-risk areas.     

广西壮族自治区结核分枝杆菌/HIV联合感染患者抗病毒治疗对死亡影响的分析

目的 分析抗病毒治疗(ART)对结核分枝杆菌/HIV联合感染患者(TB/HIV)死亡的影响。方法 收集2011年广西壮族自治区(广西)各市、县(区)结核病监测系统中既往HIV阳性和新确诊HIV阳性的结核病(TB)患者信息,经核对“中国疾病预防控制系统-艾滋病综合防治信息系统”信息,确定TB/HIV;采用回顾性对照研究方法,按是否开展ART将患者分为ART和非ART两组,用统计学方法比较两组患者特征,并计算死亡比例,采用Kaplan-Meier法分析两组生存情况,同时分析死亡优势比和开始抗结核治疗1年内ART保护率。结果 519例TB/HIV中,100例(19.3%)开展ART;开展抗结核治疗1年内84例(16.2%)死亡,其中ART组8例(9.5%),非ART组76例(占死亡患者90.5%);ART组死亡占TB/HIV总数的8.08%,非ART组死亡占TB/HIV总数的18.7%,两组差异有统计学意义(χ²=6.12,P<0.01);Kaplan-Meier生存曲线显示,ART组TB/HIV治疗开始1年内生存概率大于非ART组;两组生存曲线差异有统计学意义(P<0.05);相对于ART组,非ART组TB/HIV死亡优势比为2.31;ART组在抗结核第一年内能保护56.7%的TB/HIV免于死亡。结论 在抗结核开始1年内,非ART组TB/HIV死亡比例显着高于ART组;ART患者生存时间较非ART组长;ART可以保护半数以上TB/HIV在抗结核开始1年内免于死亡;为挽救更多生命,需不断提高TB/HIV中ART覆盖面。