Impact of mass-screening on tuberculosis incidence in a prospective cohort of Brazilian prisoners

BMC Infectious Diseases

Research Article

Ana Rita Coimbra Motta-Castro¹  Juliana Urrego²  Albert Icksang Ko³  Jason Randolph Andrews⁴  Simone Simionatto⁵  Fellipe Matos da Silva⁶  Luciana Squarizi dos Santos⁶  Renata Viebrantz Enne Sgarbi⁶  Dayse Sanchez Guimarães Paião⁶  Andrea da Silva Santos Carbone⁶  Alexandre Laranjeira Junior⁶  Vaneli Silva Martins⁶  Letícia Marques Brandão⁶  Julio Croda⁷  Maurício Antônio Pompílio⁸  Everton Ferreira Lemos⁸ 

[1] Department of Biochemical Pharmacy, Federal University of Mato Grosso do Sul, Campo Grande, Brazil;Oswaldo Cruz Foundation, Campo Grande, Brazil;Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA;Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA;Oswaldo Cruz Foundation, Salvador, Brazil;Division of Infectious Diseases and Geographic Medicine, Stanford School of Medicine, Palo Alto, CA, USA;Faculty of Ambiental and Biological Sciences, Federal University of Grande Dourados, Dourados, Brazil;Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil;Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil;Oswaldo Cruz Foundation, Campo Grande, Brazil;School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil;

关键词: Tuberculosis;    LTBI;    Mass screening;    Prisons;    Case finding;    Brazil;    Cohort;   

DOI  :  10.1186/s12879-016-1868-5

 received in 2016-06-09, accepted in 2016-09-24,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundGlobally, prison inmates are a high-risk population for tuberculosis (TB), but the specific drivers of disease and impact of mass screening interventions are poorly understood.MethodsWe performed a prospective cohort study to characterize the incidence and risk factors for tuberculosis infection and disease in 12 Brazilian prisons, and to investigate the effect of mass screening on subsequent disease risk. After recruiting a stratified random sample of inmates, we administered a questionnaire to ascertain symptoms and potential risk factors for tuberculosis; performed tuberculin skin testing (TST); collected sera for HIV testing; and obtained two sputum samples for smear microscopy and culture, from participants reporting a cough of any duration. We repeated the questionnaire and all tests for inmates who remained incarcerated after 1 year. TST conversion was defined as TST ≥10 mm and an induration increase of at least 6 mm in an individual with a baseline TST <10 mm. Cox proportional hazard models were performed to identify risk factors associated with active TB. To evaluate the impact of screening on subsequent risk of disease, we compared TB notifications over one year among individuals randomized to screening for active TB with those not randomized to screening.ResultsAmong 3,771 inmates recruited, 3,380 (89.6 %) were enrolled in the study, and 1,422 remained incarcerated after one year. Among 1,350 inmates (94.9 %) with paired TSTs at baseline and one-year follow-up, 25.7 % (272/1060) converted to positive. Among those incarcerated for the year, 10 (0.7 %) had TB at baseline and 25 (1.8 %) were diagnosed with TB over the subsequent year. Cases identified through active screening were less likely to be smear­positive than passively detected cases (10.0 % vs 50.9 %; p < 0.01), suggesting early case detection. However, there was no reduction in subsequent disease among individuals actively screened versus those not screened (1.3 % vs 1.7 %; p = 0.88). Drug use during the year (AHR 3.22; 95 % CI 1.05–9.89) and knows somebody with TB were (AHR 2.86; 95 % CI 1.01–8.10) associated with active TB during one year of follow upConclusionsMass screening in twelve Brazilian prisons did not reduce risk of subsequent disease in twelve Brazilian prisons, likely due to an extremely high force of infection. New approaches are needed to control TB in this high-transmission setting.

【 授权许可】

CC BY   
© The Author(s). 2016