High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis. Issue 1 (1st January 2018)

• Record Type: Journal Article
• Authors: Yang, Zhiqi; Zhou, Changming; Ning, Zhu; Lu, Wei; Zhao, Qi; Hu, Yi; Diwan, Vinod K.; Xu, Biao
• Is Part Of: Global health action. Volume 11:Issue 1(2018)
• Publication Date: 2018-01-01
• Subjects: Tuberculosis -- multidrug-resistance -- screening strategy -- high-risk groups -- population attributable risk; World health -- Periodicals; Global Health; World health; Periodicals; 362.1
• DOI: 10.1080/16549716.2018.1500763
• Languages: English
• ISSNs: 1654-9716

Abstract

ABSTRACT: Background : In China, less than one-fifth of multidrug-resistant tuberculosis (MDR-TB) cases are detected. MDR-TB screening is conducted amongst the following five high-risk groups of TB patients: chronic cases, close contacts of MDR-TB patients, patients with treatment failure, relapsed and returned patients, and smear-positive patients at the end of the third month of initial treatment. Objective : To estimate the possibility of detecting MDR-TB cases if only the high-risk screening strategy is applied in China. Methods : A secondary analysis was applied to the surveillance-based longitudinal data of all sputum smear-positive TB patients in Prefecture E and Prefecture W of China from 2013 to 2015. The population attributable risk (PAR) was estimated using odds ratios for five risk factors/predictors and exposure proportions amongst all MDR-TB cases. Results : A total of 3513 TB patients (2807 from Prefecture E and 706 from Prefecture W) were included. Males accounted for 77.91% (2737/3513) of the patients. The average age was 52.5 ± 20.0 years old. Overall, 40.34% (71/176) of MDR-TB patients were from the five high-risk groups during the three-year study period. The detected proportion of MDR-TB cases using the high-risk screening strategy was significantly higher in Prefecture E than in Prefecture W. The PAR% for all five risk factors/predictors was 43.4% (95% CI: 24.6–61.7%), 49.9% (95% CI: 31.3–67.0%), and 30.3% (95% CI: 12.9–50.1%) in Prefecture E and 36.6% (95% CI: 10.4–64.5%), 13.3% (95% CI: −1.7–39.7%), and −82.5% (95% CI: −117.5–−11.2%) in Prefecture W in 2013, 2014, and 2015, respectively. The PAR% for the five specific risk factors/predictors ranged from 0.4% (95% CI: −0.2–4.8%) to 21.0% (95% CI: 13.1–30.0%) in these two prefectures. Conclusion : In general, a high-risk screening strategy would miss more than half of the MDR-TB patients because they do not belong to the five high-risk groups.