9 个乌干达农村社区中成年人的社会网络特征与结核病感染之间的关联。

The Association Between Social Network Characteristics and Tuberculosis Infection Among Adults in 9 Rural Ugandan Communities.

机构信息

Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA.

Department of Biostatistics, University of Washington, Seattle, Washington, USA.

出版信息

Clin Infect Dis. 2023 Feb 8;76(3):e902-e909. doi: 10.1093/cid/ciac669.

DOI:10.1093/cid/ciac669

PMID:35982635

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10169405/

Abstract

BACKGROUND

Social network analysis can elucidate tuberculosis transmission dynamics outside the home and may inform novel network-based case-finding strategies.

METHODS

We assessed the association between social network characteristics and prevalent tuberculosis infection among residents (aged ≥15 years) of 9 rural communities in Eastern Uganda. Social contacts named during a census were used to create community-specific nonhousehold social networks. We evaluated whether social network structure and characteristics of first-degree contacts (sex, human immunodeficiency virus [HIV] status, tuberculosis infection) were associated with revalent tuberculosis infection (positive tuberculin skin test [TST] result) after adjusting for individual-level risk factors (age, sex, HIV status, tuberculosis contact, wealth, occupation, and Bacillus Calmette-Guérin [BCG] vaccination) with targeted maximum likelihood estimation.

RESULTS

Among 3 335 residents sampled for TST, 32% had a positive TST results and 4% reported a tuberculosis contact. The social network contained 15 328 first-degree contacts. Persons with the most network centrality (top 10%) (adjusted risk ratio, 1.3 [95% confidence interval, 1.1-1.1]) and the most (top 10%) male contacts (1.5 [1.3-1.9]) had a higher risk of prevalent tuberculosis, than those in the remaining 90%. People with ≥1 contact with HIV (adjusted risk ratio, 1.3 [95% confidence interval, 1.1-1.6]) and ≥2 contacts with tuberculosis infection were more likely to have tuberculosis themselves (2.6 [ 95% confidence interval: 2.2-2.9]).

CONCLUSIONS

Social networks with higher centrality, more men, contacts with HIV, and tuberculosis infection were positively associated with tuberculosis infection. Tuberculosis transmission within measurable social networks may explain prevalent tuberculosis not associated with a household contact. Further study on network-informed tuberculosis case finding interventions is warranted.

摘要

背景

社会网络分析可以阐明家庭以外的结核病传播动态，并可能为新的基于网络的病例发现策略提供信息。

方法

我们评估了乌干达东部 9 个农村社区居民（年龄≥15 岁）的社会网络特征与现患结核感染之间的关系。在普查期间登记的社会接触者被用来创建特定社区的非家庭社会网络。我们评估了社会网络结构和一级接触者（性别、人类免疫缺陷病毒[HIV]状态、结核感染）的特征是否与调整个体水平危险因素（年龄、性别、HIV 状态、结核接触、财富、职业和卡介苗[BCG]接种）后的现患结核感染（结核菌素皮肤试验[TST]阳性结果）相关，采用靶向最大似然估计法。

结果

在接受 TST 抽样的 3335 名居民中，32%的 TST 结果为阳性，4%的人报告有结核接触者。该社会网络包含 15328 名一级接触者。网络中心度最高（前 10%）（校正风险比，1.3[95%置信区间，1.1-1.1]）和接触最多男性（前 10%）（1.5[1.3-1.9]）的人比其他 90%的人更有可能患现患结核病。有≥1 名 HIV 接触者（校正风险比，1.3[95%置信区间，1.1-1.6]）和≥2 名结核感染者接触者（校正风险比，2.6[95%置信区间，2.2-2.9]）更有可能自身患有结核病。