2014—2017年南宁市农村地区MTB/HIV感染双向筛查与治疗结果分析

Bidirectional screening and treatment results of Mycobecterium tuberculosis/human immunodeficiency virus co-infection in rural areas of Nanning city, 2014-2017

目的了解2014—2017年南宁市农村地区MTB/HIV双向筛查和治疗情况,为双重感染防治工作提供科学依据。方法南宁市结核病防治机构门诊对新登记的结核病患者进行HIV抗体初筛,对初筛阳性结果进行确证。艾滋病防治机构对当年存活并可随访的HIV/AIDS患者进行结核病可疑症状筛查后,转介到当地结核病防治机构进行痰涂片和胸部影像学检查。分析2014—2017年南宁市4个县的双向筛查及双重感染患者发现和治疗情况。结果2014—2017年南宁市农村地区新登记的结核病患者HIV抗体总检测率为87.16%,不同年度间差异有统计学意义(χ^2=33.838,P<0.001),且逐年上升的趋势(χ^2趋势=32.647,P<0.001);HIV感染率为0.68%,不同年度差异无统计学意义(χ^2=5.481,P>0.05)。HIV/AIDS患者中TB检查率(χ^2=248.244,P<0.01)和TB检出率(χ^2=78.027,P<0.001)均出现波动现象,均为2016年最高(96.95%和3.50%)。MSH县发现的MTB/HIV双重感染病例数最多。MTB/HIV双重感染患者综合治疗率为54.25%,2015—2017年逐年上升(χ^2=26.241,P<0.001);抗结核成功治疗率为39.16%。结论2014—2017年南宁市的MTB/HIV双向筛查和防治工作逐步提高,但个别地区的双重感染疫情较高,仍需进一步加强和完善结核病与艾滋病综合服务机制,以提高患者诊治的可及性、治疗率及治疗效果,才能有效的控制MTB/HIV双重感染疫情。

Objective To investigate the status of bidirectional screening and treatment of Mycobecterium tuberculosis(MTB)/human immunodeficiency virus(HIV)co-infection in rural areas of Nanning city from 2014 to 2017,and to provide a scientific basis for prevention and therapy of MTB/HIV co-infection.Methods Primary screening of HIV antibody assay was carried out in newly registered tuberculosis(TB)patients in outpatient departments of TB control and treatment institutions in Nanning city,and the positive cases were verified.TB-suspicious symptom screening was performed in HIV/AIDS patients who were alive and were followed-up in HIV/AIDS prevention and treatment institutions,then the patients were referred to local TB control and treatment institutions for sputum smears and chest imaging examination.We analyzed the data concerning bidirectional screening and treatment of MTB/HIV co-infection in 4 counties of Nanning city in 2014-2017.Results The total detection rate of HIV antibody in newly registered TB patients in rural areas of Nanning city in 2014-2017 was 87.16%,the detection rates in 2014-2017 showed statistically significant differences(χ^2=33.838,P<0.001)as well as an upward tendency year by year(χ^2tendency=32.647,P<0.001).The positive rate of HIV antibody was 0.68%,without a statistically significant difference in different years(χ^2=5.481,P>0.05).The rate of TB screening(χ^2=248.244,P<0.01)and the positive rate of TB(χ^2=78.027,P<0.001)in HIV/AIDS patients were fluctuant,and the above-mentioned rates in 2016 were the highest(96.95%,3.50%).Most of patients with MTB/HIV con-infection were found in MSH county.The comprehensive treatment rate in patients with MTB/HIV con-infection was 54.25%,and the rates in 2015-2017 increased year by year(χ^2=26.241,P<0.001).The success rate of anti-TB treatment was 39.16%.Conclusions The work regarding bidirectional screening,prevention and treatment of MTB/HIV co-infection in Nanning city in 2014-2017 was gradually improved,but the epidemic of MTB/HIV co-infection in some areas was serious.It is necessary to further enhance and improve TB and HIV/AIDS comprehensive service mechanism so as to promote accessibility of patients’diagnosis and treatment,therapy rate and therapeutic efficacy and effectively control the epidemic of MTB/HIV co-infection.