尼日利亚不同类型和级别的医疗保健机构对GeneXpert MTB/RIF检测性能的评估
Assessment of GeneXpert MTB/RIF Performance by Type and Level of Health-Care Facilities in Nigeria.
作者信息
Gidado Mustapha, Nwokoye Nkiru, Ogbudebe Chidubem, Nsa Bassey, Nwadike Peter, Ajiboye Prisca, Eneogu Rupert, Useni Sani, Elom Emeka, Lawanson Adebola
机构信息
KNCV Tuberculosis Foundation/Challenge TB Project, Abuja, Lagos, Nigeria.
National TB and Leprosy Control Program, Abuja, Nigeria.
出版信息
Niger Med J. 2019 Jan-Feb;60(1):33-39. doi: 10.4103/nmj.NMJ_12_19.
SETTING
Nigeria adopted GeneXpert MTB Rif as a primary diagnostic tool were available and accessible since 2016. The current geographical coverage of GeneXpert machines by LGAs stands at 48%, with a varied access and utilization.
OBJECTIVES
To assess the association between the type and level of health facilities implementing GeneXpert MTB/Rif and performance outcome of the machines in Nigeria.
STUDY DESIGN
Retrospective secondary data analysis of GeneXpert performance for 2017 from GXAlert database. The independent variables were type and levels of health care facilities, and dependent variables were GeneXpert performance (utilization, successful test, error rates, MTB detected, and Rifampicin resistance detected).
RESULTS
Only 366 health care facilities are currently implementing and reporting GeneXpert performance, the distribution is 86.9% and 13.1% public and private health care facilities respectively, and only 6.3% of the facilities are primary health care. Of 354,321 test conducted in 2017, 91.5% were successful, and among unsuccessful test 6.8% were errors. The yield was 16.8% MTB detected (54,713) among which 6.8% had Rif resistance. The GeneXpert utilization rate was higher among private health care facilities (55.8%) compared to 33.3% among public health care facilities. There was a statistically significant difference in the number of successful test between public and private health facility-based machines as determined by one-way ANOVA (F(1,2) = 21.81, = 0.02) and between primary, secondary and tertiary level health facility-based machines (F(1,2) = 41.24, < 0.01).
CONCLUSION
Nigeria with very low TB coverage should rapidly scale-up and decentralize GeneXpert services to the private sector.
背景
自2016年以来，尼日利亚采用GeneXpert MTB Rif作为主要诊断工具，且该工具可得且可及。目前，地方政府辖区内GeneXpert机器的地理覆盖范围为48%，其获取和使用情况各不相同。
目的
评估在尼日利亚实施GeneXpert MTB/Rif的卫生设施类型和级别与该机器的性能结果之间的关联。
研究设计
对GXAlert数据库中2017年GeneXpert性能进行回顾性二次数据分析。自变量为卫生保健设施的类型和级别，因变量为GeneXpert性能（利用率、成功检测率、错误率、检测到的结核分枝杆菌以及检测到的利福平耐药性）。
结果
目前仅有366家卫生保健设施在实施并报告GeneXpert性能，其分布分别为86.9%的公共卫生保健设施和13.1%的私立卫生保健设施，且只有6.3%的设施为初级卫生保健设施。在2017年进行的354,321次检测中，91.5%的检测成功，在未成功的检测中，6.8%为错误检测。检测出结核分枝杆菌的阳性率为16.8%（54,713例），其中6.8%有耐药性。私立卫生保健设施中GeneXpert的利用率较高（55.8%），而公共卫生保健设施中的利用率为33.3%。通过单因素方差分析确定，基于公共和私立卫生设施的机器在成功检测次数上存在统计学显著差异（F(1,2) = 21.81，P = 0.02），基于初级、二级和三级卫生设施的机器之间也存在显著差异（F(1,2) = 41.24，P < 0.01）。
结论
结核病覆盖率极低的尼日利亚应迅速扩大GeneXpert服务并将其下放至私营部门。
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