Community-based targeted case finding for tuberculosis and HIV in household contacts of patients with tuberculosis in South Africa.

RATIONALE: South Africa has a high prevalence of tuberculosis (TB) and HIV-coinfected adults in whom TB is often diagnosed late in the course of disease. OBJECTIVES: Improved case-finding approaches for TB and HIV are needed to reduce mortality and prevent transmission. METHODS: We identified newly diagnosed index TB cases in a rural district and enrolled their households in a TB-HIV contact-tracing study. A group of randomly selected control households were enrolled to determine community prevalence of undetected TB and HIV. Field teams screened participants for TB symptoms, collected sputum specimens for smear microscopy and culture, provided HIV counseling and testing, and collected blood for CD4 testing. Participants were referred to public clinics for TB treatment and antiretroviral therapy. MEASUREMENTS AND MAIN RESULTS: We evaluated 2,843 household contacts of 727 index patients with TB and 983 randomly selected control household members. The prevalence of TB in household contacts was 6,075 per 100,000 (95% confidence interval, 5,789-6,360 per 100,000), whereas the prevalence detected in randomly selected households was 407 per 100,000 (95% confidence interval, 0-912 per 100,000; prevalence difference, 5,668 per 100,000; P < 0.001). TB detected among contacts was less likely to be smear-positive than in the index patients (6% vs. 22%; P < 0.001). Most contacts with culture-confirmed TB were asymptomatic. At least one case of undiagnosed TB was found in 141 (19%) of 727 contact versus 4 (1%) of 312 control households. HIV testing was positive in 166 (11%) of 1,568 contacts tested versus 76 (14%) of 521 control participants tested (odds ratio, 1.48; P = 0.02). CONCLUSIONS: Active case finding in TB contact households should be considered to improve TB and HIV case detection in high-prevalence settings, but sensitive diagnostic tools are necessary.

Investigation of spatial pattern of apnea disorder using geographic information system (GIS)-case study of Kermanshah metropolis.

Background: Apnea disorder is influenced by social and environmental factors. By assessing its hot spots and geography, the foci of this disorder and its at-risk groups can be identified for health interventions. This study was conducted to investigate the spatial pattern of apnea disorder using GIS in the Kermanshah metropolis. Methods: In cross-sectional study was conducted in kermanshah, the statistical population were 119 people (73.95% male and 26.05% female) of Kermanshah residents, which referred to the sleep center from 2012 to 2018 due to apnea disorder. Information was collected from the records of patients referred to the Sleep Disorder Center of Farabi Hospital, which is the only service center in the west part of Iran. The statistical tests were the mean center, standard distance, Getis-Ord Gi * index, nearest neighbor index, and kernel density estimation test in GIS software. Results: The spatial pattern of patients with apnea disorder has cluster formation in the Kermanshah metropolis. The age group of 50-54 had more apnea disorder than other age groups. In this age group, women were more prone to apnea than men. In terms of education, people with high education are more affected by this disorder; So that with the increase in education level, apnea disorder had also increased. Also, the findings showed that the disorder was more common in unemployed, married, overweight people with BMI (25-30), and obese people (30-40). Conclusion: The spatial pattern of patients with apnea disorder was clustered and does not correspond to the high population density centers located in the marginal and slum areas of the city. These can be used by stakeholders, including governmental organizations and health authorities at the national-regional level.