Annual Risk of Tuberculous Infection Using Different Methods in Communities with a High Prevalence of TB and HIV in Zambia and South Africa 英文参考文献.docVIP

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Annual Risk of Tuberculous Infection Using Different Methods in Communities with a High Prevalence of TB and HIV in Zambia and South Africa 英文参考文献.doc

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Annual Risk of Tuberculous Infection Using Different Methods in Communities with a High Prevalence of TB and HIV in Zambia and South Africa 英文参考文献

AnnualRiskofTuberculousInfectionUsingDifferent MethodsinCommunitieswithaHighPrevalenceofTB andHIVinZambiaandSouthAfrica KwameShanaube1*,CharalambosSismanidis2,HelenAyles1,2,NuldaBeyers3,AbSchaap1,2 ,Katherine- AnneLawrence3,AnnieBarker3,PeterGodfrey-Faussett2 1ZAMBART Project, UniversityTeachingHospital,Lusaka, Zambia,2London SchoolofHygieneandTropicalMedicine,London,United Kingdom, 3Desmond TutuTB Centre,StellenboschUniversity,SouthAfrica Abstract Background:Theannualriskoftuberculousinfection(ARTI)isakeyepidemiologicalindicatoroftheextentoftransmission inacommunity.Severalmethodshavebeensuggestedtoestimatetheprevalenceoftuberculousinfectionusingtuberculin skintestdata.ThispaperexplorestheimplicationsofusingdifferentmethodstoestimateprevalenceofinfectionandARTI. TheeffectofBCGvaccinationontheseestimatesisalsoinvestigated. Methodology/PrincipalFindings:Tuberculinsurveysamongschoolchildrenin16communitiesinZambiaand8inSouth Africa(SA)wereperformedin2005,aspartofbaselinedatacollectionandforrandomisationpurposesoftheZAMSTAR study. Infection prevalence and ARTI estimates were calculated using five methods: different cut-offs with or without adjustments for sensitivity, the mirror method, and mixture analysis. A total of 49,835 children were registered for the surveys,ofwhich25,048(50%)hadskintestsdoneand22,563(90%)ofthosetestedwereread.Infectionprevalencewas higherinthecombinedSAthanZambiancommunities.Themirrormethodresultedintheleastdifferenceof7.8%,whereas that estimated by the cut-off methods varied from 12.2% to 17.3%. The ARTI in the Zambian and SA communities was between0.8%and2.8%and2.5%and4.2%respectively,dependingonthemethodused.IntheSAcommunities,theARTI washigheramongtheyoungerchildren.BCGvaccinationhadlittleeffectontheseestimates. Conclusions/Significance:ARTIestimatesaredependentonthecalculationmethodused.Allmethodsagreedthattherewere substantialdifferencesininfectionprevalenceacrossthecommunities,withhigherratesinSA.AlthoughTBnotificationrates havein