PDF(Pubmed)
Abstract：
BACKGROUND: Tuberculosis (TB) is more than ten times higher in prisons compared to the general population, and HIV-infected persons are at increased risk of developing active TB and death. In the World Health Organization (WHO) African region, however, where the TB and HIV coinfections are highest, and prisons rarely factored in national disease surveillance, epidemiological data to inform TB control interventions in correctional facilities is limited. In this study, we assessed the prevalence of TB and HIV coinfections, as well as the factors associated with coinfections in our study setting.
METHODS: This was a prospective cross-sectional study among 157 adult (≥ 18 years) prisoners presenting with symptoms of pulmonary TB at Shimo La Tewa Prison, Kenya, between January and June 2023. The study excluded those with a history of anti-TB drugs use or on treatment follow-up and collected demographic and clinical characteristics data using a questionnaire. Sputum samples were collected and processed immediately using Xpert® MTB/RIF assay or stored at 4 °C for three (3) days in case of delay.
RESULTS: The overall prevalence of TB among inmates with presumptive pulmonary TB was 10.2%, 95% CI 6.37-16.91% (16/157), HIV 19.1%, 95% CI 13.73-25.97% (30/157). All the TB cases were positive for HIV (16/16, 100%), translating to TB/HIV coinfection of 10.2%, 95% CI 6.37-16.91% (16/157), and there was no rifampicin resistance. TB and HIV coinfection cases were found among underweight (100%, 16/16) prisoners. The independent factors associated with TB and HIV coinfections were education level (adjusted OR = 0.17, p = 0.007), smoking history (adjusted OR = 3.01, p = 0.009) and illegal drug use history (adjusted OR = 4.55, p = 0.044).
CONCLUSIONS: We report a high prevalence of pulmonary TB and HIV coinfections among adult inmates with presumptive pulmonary TB in Kenya, with education level, smoking status, and illegal drug use as the independent factors associated with the coinfection. The authority should take measures to protect HIV-positive prisoners from TB, focusing on education, nutrition, smoking, and illegal drug use.
METHODS: This was a prospective cross-sectional study among 157 adult (≥ 18 years) prisoners presenting with symptoms of pulmonary TB at Shimo La Tewa Prison, Kenya, between January and June 2023. The study excluded those with a history of anti-TB drugs use or on treatment follow-up and collected demographic and clinical characteristics data using a questionnaire. Sputum samples were collected and processed immediately using Xpert® MTB/RIF assay or stored at 4 °C for three (3) days in case of delay.
RESULTS: The overall prevalence of TB among inmates with presumptive pulmonary TB was 10.2%, 95% CI 6.37-16.91% (16/157), HIV 19.1%, 95% CI 13.73-25.97% (30/157). All the TB cases were positive for HIV (16/16, 100%), translating to TB/HIV coinfection of 10.2%, 95% CI 6.37-16.91% (16/157), and there was no rifampicin resistance. TB and HIV coinfection cases were found among underweight (100%, 16/16) prisoners. The independent factors associated with TB and HIV coinfections were education level (adjusted OR = 0.17, p = 0.007), smoking history (adjusted OR = 3.01, p = 0.009) and illegal drug use history (adjusted OR = 4.55, p = 0.044).
CONCLUSIONS: We report a high prevalence of pulmonary TB and HIV coinfections among adult inmates with presumptive pulmonary TB in Kenya, with education level, smoking status, and illegal drug use as the independent factors associated with the coinfection. The authority should take measures to protect HIV-positive prisoners from TB, focusing on education, nutrition, smoking, and illegal drug use.
摘要：
背景：监狱中的结核病（TB）比普通人群高十倍以上，艾滋病毒感染者患活动性结核病和死亡的风险增加。在世界卫生组织（世卫组织）非洲地区，然而,结核病和艾滋病毒合并感染最高的地方，监狱很少被纳入国家疾病监测，为惩教设施中的结核病控制干预提供信息的流行病学数据有限。在这项研究中,我们评估了结核病和艾滋病毒合并感染的患病率，以及我们研究环境中与合并感染相关的因素。
方法：这是一项前瞻性横断面研究，对ShimoLaTewa监狱的157名成年（≥18岁）囚犯表现出肺结核症状，肯尼亚,2023年1月至6月。该研究排除了有抗结核药物使用史或治疗随访史的患者，并使用问卷收集了人口统计学和临床特征数据。收集痰样品并立即使用Xpert®MTB/RIF测定法处理或在延迟的情况下在4°C下储存三(3)天。
结果：在患有肺结核病的囚犯中，结核病的总体患病率为10.2％，95%CI6.37-16.91%（16/157），艾滋病毒19.1%，95%CI13.73-25.97%（30/157）。所有结核病例HIV阳性（16/16，100%），转化为10.2%的结核病/艾滋病毒合并感染率，95%CI6.37-16.91%（16/157），也没有利福平抵抗.在体重不足的人群中发现了结核病和艾滋病毒合并感染病例(100%，16/16）囚犯。与结核病和HIV合并感染相关的独立因素是教育水平（校正OR=0.17，p=0.007），吸烟史(校正后OR=3.01,p=0.009)和非法用药史(校正后OR=4.55,p=0.044).
结论：我们报告说，在肯尼亚患有推定肺结核的成年囚犯中，肺结核和艾滋病毒合并感染的患病率很高，受教育程度,吸烟状况,和非法药物使用是与合并感染相关的独立因素。当局应采取措施保护艾滋病毒阳性囚犯免受结核病的侵害，注重教育,营养,吸烟,非法使用毒品。
方法：这是一项前瞻性横断面研究，对ShimoLaTewa监狱的157名成年（≥18岁）囚犯表现出肺结核症状，肯尼亚,2023年1月至6月。该研究排除了有抗结核药物使用史或治疗随访史的患者，并使用问卷收集了人口统计学和临床特征数据。收集痰样品并立即使用Xpert®MTB/RIF测定法处理或在延迟的情况下在4°C下储存三(3)天。
结果：在患有肺结核病的囚犯中，结核病的总体患病率为10.2％，95%CI6.37-16.91%（16/157），艾滋病毒19.1%，95%CI13.73-25.97%（30/157）。所有结核病例HIV阳性（16/16，100%），转化为10.2%的结核病/艾滋病毒合并感染率，95%CI6.37-16.91%（16/157），也没有利福平抵抗.在体重不足的人群中发现了结核病和艾滋病毒合并感染病例(100%，16/16）囚犯。与结核病和HIV合并感染相关的独立因素是教育水平（校正OR=0.17，p=0.007），吸烟史(校正后OR=3.01,p=0.009)和非法用药史(校正后OR=4.55,p=0.044).
结论：我们报告说，在肯尼亚患有推定肺结核的成年囚犯中，肺结核和艾滋病毒合并感染的患病率很高，受教育程度,吸烟状况,和非法药物使用是与合并感染相关的独立因素。当局应采取措施保护艾滋病毒阳性囚犯免受结核病的侵害，注重教育,营养,吸烟,非法使用毒品。
