2016至2021年南投縣山地原鄉執行潛伏結核感染篩檢與治療之經驗分享

Screening and Treating latent tuberculosis infection in Mountain Indigenous Communities in Nantou County, 2016–2021

臺灣結核病發生率逐年降低，但2016年山地原鄉平均發生率仍高於全國平均3倍之多。為此，我國於該年起逐步推動山地原鄉潛伏結核感染(latent tuberculosis infection, LTBI)計畫，結合醫療及保健資源，搭配胸部X光巡檢、整合式篩檢或其他團體活動，導入部落LTBI全面檢驗，提供潛伏結核感染者適當治療與都治送藥關懷服務，以積極阻斷傳染源，有效降低整體發病機率。
本文運用2016至2021年南投縣山地原鄉地區仁愛及信義鄉已執行8村里之潛伏結核感染篩檢與治療清單進行成果分析，計畫執行期間LTBI平均篩檢率為47.4%，而治療評估前確診結核病約佔所有LTBI陽性數的0.8%、治療中確診約佔0.2%，顯示LTBI篩檢除尋找尚未發病的潛伏結核感染者外，同時落實LTBI治療前評估可及早發現活動性結核病人之重要性。統計分析LTBI治療追蹤一年以上後續結核病發病機率，未接受治療者的相對風險約為完成治療者的7倍，另LTBI短程治療處方完治率相較傳統處方9個月isoniazid高。顯示LTBI篩檢及治療之公共衛生政策推動頗具成效，為重要之結核病防治政策，整體結核病發生率呈下降趨勢。
藉由歷年實際推動本計畫，篩檢涵蓋率仍無法達到全面性，部分檢驗陽性者亦有拒絕治療情況，顯示強化民眾疾病認知及增進篩檢治療意願，仍為山地鄉結核病防治之一大挑戰。公衛端期透過與教會、學校、文健站、村鄰長及耆老宣導拜訪、扎根教育提升健康識能、溝通衛教、了解民眾拒絕篩檢及治療原因並耐心溝通克服困境，以達成降低山地原鄉結核病發生率之最終目標。

The incidence of tuberculosis in Taiwan has been decreasing annually, but in 2016, the average incidence in mountain indigenous regions was still nearly three times the national average. To proactively disrupt the source of transmission and effectively reduce tuberculosis occurrence, the Taiwan Centers for Disease Control (CDC) initiated the Latent Tuberculosis Infection (LTBI) screening and treatment program in mountain indigenous regions in 2016. This program collaborated with relevant healthcare resources and screening methods to implement comprehensive LTBI screening in indigenous communities, and provided treatment and medication delivery services to individuals with LTBI.
We analyzed LTBI screening and treatment outcomes in eight villages in Renai and Xinyi Townships in Nantou County from 2016 to 2021. During the study period, the average LTBI screening rate was 47.4%. Through pre-treatment evaluation, 0.8% of all LTBI-positive cases were identified to have active tuberculosis, and an additional 0.2% were diagnosed during treatment. This underscores the importance of detecting LTBI individuals who had yet to manifest tuberculosis and implementing pre-treatment evaluation in identifying active tuberculosis patients. Statistical analysis of LTBI treatment follow-up for one year or more revealed that the relative risk of developing tuberculosis for those who did not receive treatment was 7 times higher than that for those who completed treatment. Furthermore, the completion rate using a short-course LTBI treatment regimen was higher than the traditional 9-month isoniazid regimen. These findings suggest that implementing public health policies for LTBI screening and treatment has been effective in enhancing tuberculosis prevention and control, and contributing to an overall reduction of tuberculosis incidence.
Despite the program's implementation, we still could not screen all people in indigenous communities, and not all individuals with LTBI received treatment. We recommend that public health authorities actively engage in community outreach and collaborate with churches, schools, community health centers, village leaders, and elders to enhance awareness of tuberculosis and increase people's willingness to participate in screening and treating of LTBI, and ultimately achieving the goal of reducing the tuberculosis incidence in mountain indigenous regions.