背景:巴拿马是中美洲八个旨在到2022年消除疟疾的国家之一。疟疾集中在古纳亚拉等土著和偏远地区,一个政治自治的地区,获得卫生服务的机会有限,病例主要是通过间歇性主动监测发现的。为了改善常规护理,GunaYala当局和卫生部共同努力,试行了一个配备快速诊断测试和治疗的社区卫生工作者网络。描述了该飞行员的影响。
方法:使用积极CHW的努力所针对的村庄比例来衡量获得护理的机会。通过标准监测和病例管理措施评估流行病学影响。使用比例或比率差异测试来比较试点之前(2014年10月至2016年9月)和试点期间(2016年10月至2018年9月)的措施。
结果:在41个目标社区中的39个(95%)中放置了活跃的CHW。在飞行员的时候,CHW检测到该地区所有报告病例的61%。CHW测试人群的测试阳性率(22%)高于通过主动监测进行测试的人群,之前(3.8%)和试点期间(2.9%)。从前期试点到试点阶段,年度血液检查率下降(每100例9.8例vs.8.0/100),测试阳性率增加(4.2%至8.5%,X2=126.3,p<0.001),报告的发病率增加(4.1例/1000至6.9例/1000[发病率比率=1.83,95%CI1.52,2.21])。在症状发作当天测试的病例百分比从8%增加到27%,在测试当天治疗的病例百分比从26%增加到84%。
结论:CHW网络允许用强大的被动病例检测替代常规主动监测,从而实现更有针对性和及时的检测和治疗。与主动监测相比,CHW检测的检测阳性率更高,这表明他们在高风险人群中发现了以前没有从诊断和治疗中受益的病例。通过该CHW网络获得的监测数据可用于更好地将主动病例检测目标定位到风险最高的人群。
BACKGROUND: Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described.
METHODS: Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and
case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018).
RESULTS: An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%.
CONCLUSIONS: The CHW network allowed for replacement of routine active surveillance with strong passive
case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active
case detection to populations at highest risk.