Study on the role of the prefectural tuberculosis designated hospital to improve the case finding of pulmonary tuberculosis in economic undeveloped areas of Jiangxi Province

doi:10.19982/j.issn.1000-6621.20220436

Abstract

Abstract:

Objective: To explore the role of prefectural tuberculosis designated hospital to improve the case finding of pulmonary tuberculosis (PTB) and rifampicin-resistant pulmonary tuberculosis (RR-PTB). Methods: The information on tuberculosis diagnosis and drug resistance testing of active PTB patients (excluding patients with simple tuberculous pleurisy) in Ganzhou were derived from the Tuberculosis Management Information System, a subsystem of China Disease Control and Prevention Information System before (2017—2018) and after (2019—2020) the implementation of the project “Study on improving the case finding of pulmonary tuberculosis in poor areas”. While, the diagnosis and drug resistance test information of suspected PTB cases in the Fifth People’s Hospital of Ganzhou (Ganzhou Fifth Hospital) were derived from the Hospital Information System. The differences of detection in PTB and RR-PTB cases were analyzed and compared before and after the implementation of the project. Results: From 2017 to 2020, a total of 9279 suspected PTB cases were treated in Ganzhou Fifth Hospitals, and 7619 cases of PTB patients were diagnosed, including 385 RR-PTB cases. The proportion of GeneXpert MTB/RIF testing and the rate of bacteriologically confirmed PTB in patients with suspected PTB increased from 7.71% (361/4682) and 36.39% (1383/3801) before the project to 66.70% (3066/4597) and 52.46% (2003/3818) after implementation, respectively, with statistically significant differences (χ²=3464.784, P<0.001; χ²=199.388, P<0.001). After the implementation of the project, the proportion of bacteriologically confirmed PTB and RR-PTB cases detected in Ganzhou Fifth Hospitals reached 33.97% (2003/5897) and 81.31% (248/305) of the whole prefecture, respectively. Among them, 34.55% (692/2003) of bacteriologically confirmed PTB and 28.63% (71/248) of RR-PTB were smear-negative cases detected by GeneXpert MTB/RIF test. Conclusion: The case finding of PTB and RR-PTB in the whole city can be improved if the prefectural designated hospitals could adopt appropriate tuberculosis diagnosis techniques and the strategy of case finding, provide free screening for all suspected tuberculosis cases regardless of region, and interconnect tuberculosis diagnostic information with the medical and health institution in county.

Key words: Tuberculosis, pulmonary, Hospitals, special, Progressive patient care, Case finding, Comparative study

CLC Number:

R521
R8

Liu Yueyuan, Su Wei, Zheng Jiangang, Wang Meng, Zeng Zhong, Huang Qin, Xie Tian, Li Renzhong. Study on the role of the prefectural tuberculosis designated hospital to improve the case finding of pulmonary tuberculosis in economic undeveloped areas of Jiangxi Province[J]. Chinese Journal of Antituberculosis, 2023, 45(3): 279-284. doi: 10.19982/j.issn.1000-6621.20220436

Figures/Tables 4

References 15

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时点年度	疑似肺结核患者数	涂片		GeneXpert		传统培养		活动性肺结核			涂阴后经检测为病原学阳性
时点年度	疑似肺结核患者数	检测数	检测率 (%)	检测数	检测率 (%)	培养数	培养率 (%)	患者数	病原学阳性数	病原学阳性率 (%)	仅 GeneXpert 阳性患者数	占病原学阳性比例 (%)	仅培养阳性患者数	占病原学阳性比例(%)
项目实施前
2017	2365	2365	100.00	185	7.82	494	20.89	1901	661	34.77	0	0.00	8	1.21
2018	2317	2317	100.00	176	7.60	783	33.79	1900	722	38.00	12	1.66	26	3.60
小计	4682	4682	100.00	361	7.71	1277	27.27	3801	1383	36.39	12	0.87	34	2.46
项目实施后
2019	2149	2149	100.00	1142	53.14	434	20.20	1945	961	49.41	262	27.26	55	5.72
2020	2448	2448	100.00	1924	78.59	514	21.00	1873	1042	55.63	430	41.27	62	5.95
小计	4597	4597	100.00	3066	66.70	948	20.62	3818	2003	52.46	692	34.55	117	5.84
合计	9279	9279	100.00	3427	36.93	2225	23.98	7619	3386	44.44	704	20.79	151	4.46

时点年度	活动性肺结核			病原学阳性肺结核			病原学阳性率(%)		肺结核患者GeneXpert检测
时点年度	赣州市患者数	赣州五院确诊的患者数	占比 (%)	赣州市患者数	赣州五院确诊的患者数	占比 (%)	赣州市	赣州五院	赣州市检测数	赣州市检测率 (%)	赣州五院检测数	赣州五院检测率 (%)
项目实施前
2017	7336	1901	25.91	3225	661	20.50	43.96	34.77	1438	19.60	173	9.10
2018	6609	1900	28.75	2921	722	24.72	44.20	38.00	2173	32.88	171	9.00
小计	13945	3801	27.26	6146	1383	22.50	44.07	36.39	3611	25.89	344	9.05
项目实施后
2019	5790	1945	33.59	3013	961	31.90	52.04	49.41	4955	85.58	938	48.23
2020	4718	1873	39.70	2884	1042	36.13	61.13	55.63	4315	91.46	1349	72.02
小计	10508	3818	36.33	5897	2003	33.97	56.12	52.46	9270	88.22	2287	59.90
合计	24453	7619	31.16	12043	3386	28.12	49.25	44.44	12881	52.68	2631	34.53

时点年度	利福平耐药患者数	涂阴经GeneXpert检测发现利福平耐药		涂阴经传统药敏试验发现利福平耐药
时点年度	利福平耐药患者数	患者数	占比(%)	患者数	占比(%)
项目实施前
2017	41	0	0.00	0	0.00
2018	96	0	0.00	0	0.00
小计	137	0	0.00	0	0.00
项目实施后
2019	129	27	20.93	1	0.78
2020	119	44	36.97	2	1.68
小计	248	71	28.63	3	1.21
合计	385	71	18.44	3	0.78

时点年度	赣州市利福平耐药患者数	赣州五院确诊利福平耐药患者数	占比 (%)
项目实施前
2017	86	41	47.67
2018	121	96	79.34
小计	207	137	66.18
项目实施后
2019	160	129	80.63
2020	145	119	82.07
小计	305	248	81.31
合计	512	385	75.20