2019-2023年高雄市茂林區執行山地原鄉結核病防治經驗分享

Tuberculosis Prevention and Control in Mountainous Indigenous Areas: Insights from Maolin District, Kaohsiung City, 2019–2023

山地原鄉為結核病高發生率地區，且多為醫療資源缺乏之偏遠地區。現行山地原鄉主動發現策略是採胸部X光巡迴篩檢方式，並轉介篩檢結果異常者及早接受適當診治。針對交通受阻X光巡迴車無法到達之地區、行動不便或是臥床，無法站立接受胸部X光篩檢者，會以「結核病風險及症狀問卷」搭配痰液檢測取代胸部X光篩檢，然而仍有民眾未定期或從未參與衛生所提供之篩檢服務。
2019–2023年期間，茂林區衛生所搭配公私部門協力舉辦篩檢活動，積極安排篩檢場次，運用社區資源將疾病認知深植於民眾生活中，且透過活動增加民眾篩檢普及性並提升結核病防治成效，將有助於主動篩檢成效，藉此找出潛藏社區中之結核病個案，達成降低山地原鄉結核病發生率。
茂林區執行山地原鄉結核病防治工作成效斐然，主動發現計畫篩檢率為全國第一，發生率逐年下降至零。本篇為高雄市茂林區2019–2023年期間執行「山地原鄉結核病主動發現計畫」經驗分享，提供全國各山地原鄉推動結核病防治策略之參考。

Mountain indigenous areas face disproportionately high tuberculosis (TB) incidence rates due to their remote locations and limited medical resources. Active TB detection in these regions primarily relies on mobile chest X-ray screenings, which facilitate early diagnosis and treatment for individuals with abnormal findings. For those in inaccessible locations or unable to undergo chest X-rays due to immobility, alternative methods combining a ''TB Risk and Symptoms Questionnaire'' with sputum testing are employed. Despite these efforts, challenges persist, as some individuals either participate irregularly or abstain entirely from screening programs. Addressing these gaps is crucial to advancing TB control and ensuring equitable access to healthcare in these underserved communities.
From 2019 to 2023, the Maolin District Health Center, in collaboration with public and private sectors, implemented targeted TB screening initiatives. These efforts included organizing screening sessions and leveraging community resources to integrate disease awareness into daily life. The primary objectives were to enhance public participation in screening, strengthen TB prevention and control measures, and improve active case detection. By identifying undiagnosed TB cases within the community, these initiatives significantly reduced TB incidence in mountain indigenous areas.
The TB prevention and control efforts in Maolin District achieved exceptional results, including the highest screening rate for active detection programs nationwide and an annual decline in TB incidence, ultimately achieving zero cases. This article highlights the experiences of the Mountain Indigenous TB Active Detection Program implemented in Maolin District, Kaohsiung City, from 2019 to 2023. These insights offer a valuable reference for developing effective TB prevention and control strategies in other mountain indigenous regions nationwide.