| ObjectiveThis thesis tries to understand the contact investigation implementation status in close contact, and analysis the feasibility of active case finding in household contact of tuberculosis patients, we could provide a scientific evidence for the modification and improvement of screening strategies in household contact of tuberculosis patients.MethodThis paper relies on the 12th Five-Year major projects "tuberculosis incidence and intervention pattern" study area. Selected the 28 survey sites of 10 counties as the research site.This study is divided into the following three parts:1. By exporting data from "national tuberculosis management information system" of country where the survey points selected in 2010-2012, and conducting the semi-structured qualitative interviews to relevant objects.the thesis tried to understand the contact investigation implementation status in close contact;2. Through the active case finding of household contacts in the survey points from 2013-2015, the thesis tried to understand the contact investigation implementation status in close contact.3. Based on the second parts, through the literature design of the household contact screening strategy, and combined with the data of active case finding and the data of qualitative interviews, we could provide a scientific evidence for the modification and improvement of screening strategies in household contact of tuberculosis patients.Result1.2010-2012,8 counties of the 10 counties were screened close contact of smear positive pulmonary tuberculosis per the national tuberculosis control programme, the remaining two districts (Minhang District, Shanghai Cityand Jiangyou City, Sichuan Province) were screened close contact of active pulmonary tuberculosis.From 2010 to 2012, eight counties registered close contact of smear positive pulmonary tuberculosis with a total of 13585, among them 1784 contacts had tuberculosis suspicious symptoms, the symptoms detected rate was 13.13%; and 1770 received tuberculosis examination, the examination rate of 99.22%; 24 cases of active pulmonary tuberculosis patients ware detected in contacts with suspicious symptoms, the detected rate was 13.56 per thousand. The detection rate of suspicious symptoms in close contact in 3 years was 18.37%(943/5134),11.38%(501/4404), and 8.40% (340/4047), it showed a downward trend, and the difference was statistically significant (P<0.05). The detection rates of patients in contacts had suspicious symptoms in 3 years were 19.29%(18/933),8.05%(4/497), and 5.88%(2/340), showed a downward trend year by year, and the difference was statistically significant (P<0.05). The detection rate of suspicious symptoms in household contacts 14.06% (1747/12427) was higher than that of non household close contacts 3.20%(37/1158), and the difference was statistically significant (P<0.05). The detection rate of the patients in household close contact 13.27%(23/1733) was lower than that of the non household close contacts 27.03%(1/37), and the difference was not statistically significant (P>0.05).8 counties registered a total of 15952 cases of pulmonary tuberculosis patients and the contribution rate of pulmonary tuberculosis patients detected from close contacts were 1.50 per thousand. Qualitative interview results show that the current strategy screening close contact of smear positive tuberculosis patients found the effect was general, lack of personnel in the implementation and lack of funds is the main problem.2. The active case finding has detected 881 tuberculosis patient, and found 1109 household of 547 index patients, among them 635 contacts received examination for TB and TB examination rate 57.26%;Seventeen tuberculosis patients were dignosed in household contact who received TB examination,and the detection rate were 26.77 per thousand, of which 2 cases were smear positive pulmonary. Four tuberculosis patients were diagnosed in household contacts of smear positive patients (1 of them were smear positive), and all of whom had no suspicious symptoms. Forteen contacts who had suspicious symptoms were detected, and of whom were only 2 tuberculosis patients were diagnosed. Among the 17 cases of tuberculosis patients who were detected in household, only 2 cases had suspicious symptoms.3. There are six screening strategies under research. The strategy 1:tuberculosis examination will be carry out if household contact of smear positive tuberculosis patients have TB suspicious symptoms (cough, expectoration more than two weeks, or hemoptysis); The strategy 2:tuberculosis examination will be carry out in all household contact of smear positive tuberculosis patients patients; The strategy 3: tuberculosis examination will be carry out if household contact of active tuberculosis patients have TB suspicious symptoms; The strategy 4:tuberculosis examination will be carry out in all household contact of smear positive tuberculosis patients and household of smear negative tuberculosis patients who have TB suspicious symptoms; The strategy 5:on the basis of strategy 4, household contact of smear negative patients who is key population or BMI<18.5 will have TB examination; The strategy 6:tuberculosis examination will be carry out in all household contact of active tuberculosis patients.4. The cost of X-ray was estimate 60 yuan per contscts, sputum examination fees for 57.95 yuan per contscts. Among the 635 contacts who received TB examination 635 had chest X-ray examination,40 had sputum test, the total cost was 40418 yuan. The strategy 1 had detected no pulmonary tuberculosis patients. The strategy 5 had the highest cost-effectiveness, which detected 16 tuberculosis patients in household contact with a total cost of 30937.5 yuan. Strategy 5 costed 1289.14 yuan to detected one TB patients, and the sensitivity is 94.12%. The strategy 6 detected all TB patients in household contact. The total cost is 40418 yuan, and detected one case cost 2377.53 yuan.Conclusion1. The screening strategy of close contact of smear positive TB patients needs to be improved2. The country can choose the screen strategy depends on their needs.1) In better economic conditions area, in order to find more patients, screening strategy 6 can be taken; 2) In area that the economic condition is inefficient, in order to be more effective and cost-effective, screening strategy 5 can be taken... |
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