PDF(Pubmed)
Abstract：
The 2021 tuberculosis (TB) preventive treatment guidelines in India included silicosis as a screening group, yet latent TB infection (LTBI) testing for silica-dust-exposed individuals is underemphasized. Focusing on an estimated 52 million silica-dust-exposed workers, particularly agate-stone workers in Khambhat, Gujarat, our study aims to estimate LTBI prevalence, identify predictors, and gather insights from TB and silicosis experts. Employing a sequential explanatory mixed-methods approach, a cross-sectional study involved 463 agate-stone workers aged ≥ 20 years in Khambhat, using IGRA kits for LTBI testing. In-depth interviews with experts complemented quantitative findings. Among agate-stone workers, 58% tested positive for LTBI, with predictors including longer exposure, type of work, and BCG vaccination. Our findings reveal a nearly double burden of LTBI compared to the general population, particularly in occupations with higher silica dust exposure. Experts advocate for including silica-dust-exposed individuals in high-risk groups for LTBI testing, exploring cost-effective alternatives like improved skin sensitivity tests, and shorter TB preventive treatment regimens to enhance compliance. Future research should explore upfront TB preventive treatment for silica-dust-exposed individuals with high LTBI prevalence and optimal exposure duration. This study underscores the urgent need for policy changes and innovative approaches to TB prevention among silica-dust-exposed populations, impacting global occupational health strategies.
摘要：
印度的2021年结核病（TB）预防性治疗指南将矽肺作为筛查组，然而,对暴露于二氧化硅粉尘的个体的潜伏性结核感染(LTBI)检测没有得到充分重视.关注估计有5200万接触二氧化硅粉尘的工人，尤其是Khambhat的玛瑙石工人，古吉拉特邦,我们的研究旨在估计LTBI的患病率，确定预测因子，并收集结核病和矽肺病专家的见解。采用顺序解释性混合方法方法，一项横断面研究涉及Khambhat的463名年龄≥20岁的玛瑙石工人，使用IGRA试剂盒进行LTBI测试。与专家的深入访谈补充了定量发现。在玛瑙石工人中，58％的LTBI检测呈阳性，预测因素包括更长的暴露，工作类型,和BCG疫苗接种。我们的研究结果表明，与普通人群相比，LTBI的负担几乎是两倍，特别是在接触二氧化硅粉尘较高的职业中。专家主张将暴露于二氧化硅粉尘的个人纳入高危人群进行LTBI测试，探索具有成本效益的替代方案，如改善皮肤敏感性测试，和更短的结核病预防治疗方案，以提高依从性。未来的研究应该探索对LTBI高患病率和最佳暴露持续时间的二氧化硅粉尘暴露个体的预先结核病预防性治疗。这项研究强调了在暴露于二氧化硅粉尘的人群中，迫切需要政策变化和创新方法来预防结核病。影响全球职业卫生战略。
