Identifying High-Risk Tuberculosis Cases: Implementation of a Programmatic Screening Tool in Bengaluru.

IF 1.5 Q4 INFECTIOUS DISEASES
International Journal of Mycobacteriology Pub Date : 2025-07-01 Epub Date: 2025-09-15 DOI:10.4103/ijmy.ijmy_53_25
P K Sreenath Menon, B N Sharath, M D Sangeetha, R S Reshma, T M Sibi, L Ashwini
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引用次数: 0

Abstract

Background: Tuberculosis (TB) remains a significant global health challenge, causing 1.3 million deaths in 2020. The COVID-19 pandemic has further exacerbated the TB burden, leading to an 11% rise in TB mortality in India from 2019 to 2020. The World Health Organization aims to reduce TB deaths by 90% by 2030 and 95% by 2035. Early identification and management of severely ill TB patients are crucial for achieving these targets. This study aimed to identify adult TB patients at high risk of severe illness (HRSI) using a programmatic screening tool, assess referral linkages, and evaluate care outcomes within the first 7 days post-diagnosis in Bengaluru, India.

Methods: A cross-sectional study was conducted over 18 months (August 2022 to July 2023) across five Tuberculosis Units in the Bruhat Bengaluru Mahanagara Palike district. Data were collected from National Tuberculosis Elimination Program records and patient interviews, including 263 adult drug-sensitive TB patients diagnosed at public health facilities. Patients were screened for HRSI within 7 days of diagnosis using a tool assessing body mass index (BMI), respiratory rate, and oxygen saturation. Descriptive statistics summarized patient characteristics and outcomes, and associations were analyzed using Chi-square and Fisher's exact tests.

Results: Of the 263 TB patients screened, 20.9% were identified as being at HRSI. Among these high-risk patients, 73.3% accessed inpatient care, with 51% seeking treatment at district hospitals and 20% at private hospitals. Inpatient mortality among high-risk patients was 19.4%, while no deaths were reported among those managed as outpatients. Key severity indicators included BMI ≤14 kg/m2 (12%), respiratory rate >24 breaths/min (3%), oxygen saturation <94% (7%), and inability to stand without support (8%). High-risk status was more prevalent among patients over 65 years of age, males, those with microbiologically confirmed or smear-positive pulmonary TB, HIV-reactive status, and diabetes mellitus.

Conclusion: Early identification and referral of TB patients at HRSI are essential to reduce mortality. The study highlights the effectiveness of a simple screening tool in routine programmatic settings and underscores the need for targeted interventions and improved healthcare access for high-risk TB patients in India.

识别高风险结核病病例:在班加罗尔实施一种程序性筛查工具。
背景:结核病(TB)仍然是一个重大的全球卫生挑战,在2020年造成130万人死亡。2019冠状病毒病大流行进一步加剧了结核病负担,导致2019年至2020年印度结核病死亡率上升11%。世界卫生组织的目标是到2030年将结核病死亡人数减少90%,到2035年减少95%。早期发现和管理重症结核病患者对于实现这些目标至关重要。本研究旨在利用程序性筛查工具确定印度班加罗尔成年结核病高危重症患者(HRSI),评估转诊联系,并评估诊断后最初7天内的护理结果。方法:在Bruhat Bengaluru Mahanagara Palike区的五个结核病单位进行了为期18个月(2022年8月至2023年7月)的横断面研究。数据收集自国家消除结核病规划记录和患者访谈,包括263名在公共卫生机构诊断出的对药物敏感的成年结核病患者。在诊断的7天内,使用评估体重指数(BMI)、呼吸频率和氧饱和度的工具对患者进行HRSI筛查。描述性统计总结了患者的特征和结果,并使用卡方检验和Fisher精确检验分析相关性。结果:在263名筛查的结核病患者中,20.9%被确定为HRSI。在这些高危患者中,73.3%接受住院治疗,其中51%在地区医院治疗,20%在私立医院治疗。高危患者的住院死亡率为19.4%,而作为门诊患者管理的患者中无死亡报告。关键严重程度指标包括BMI≤14 kg/m2(12%)、呼吸频率>24次呼吸/min(3%)、血氧饱和度。结论:早期发现并转诊结核病患者对降低死亡率至关重要。该研究强调了一种简单的筛查工具在常规规划环境中的有效性,并强调了印度需要有针对性的干预措施和改善高风险结核病患者的医疗保健可及性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.20
自引率
25.00%
发文量
62
审稿时长
7 weeks
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