1
|
John S, Abdulkarim S, Katlholo T, Smyth C, Basason H, Rahman MT, Creswell J. Using a Knowledge and Awareness Survey to Engage and Inform a Community-Based Tuberculosis Intervention among Nomads in Adamawa State, Nigeria. Trop Med Infect Dis 2024; 9:167. [PMID: 39195605 PMCID: PMC11359801 DOI: 10.3390/tropicalmed9080167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/09/2024] [Accepted: 07/18/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Nomadic populations are frequently isolated and vulnerable to diseases including tuberculosis (TB) and human immunodeficiency virus (HIV) due to limited access to health-related information and services, poverty, and social exclusion. We designed and implemented community-driven and -based outreach for TB and HIV based on the results of a TB knowledge, attitude, and practices (KAP) survey in Adamawa, Nigeria. METHODS We conducted a cross-sectional study on KAP among nomads using an adapted WHO survey. A TB and HIV community-level active case-finding intervention among nomadic populations was planned and delivered based on the KAP survey results. RESULTS Among 81 respondents, 26 (32.1%) knew what caused TB. More than 60% reported no health facilities in their community. Radio and healthcare workers were primary sources of information on health. Using community input, we developed and broadcasted radio jingles to sensitize people to TB services. Outreach initiatives led to the verbal screening of 61,891 individuals and 306 were diagnosed with TB. Additionally, 4489 people underwent HIV testing, and 69 were HIV-positive, all of whom were linked to treatment. CONCLUSIONS The results of KAP surveys can inform the design of evidence-based TB and HIV community-driven and -based case-finding interventions in rural Nigeria among nomadic populations.
Collapse
Affiliation(s)
- Stephen John
- Janna Health Foundation, Yola 640231, Nigeria; (S.J.); (H.B.)
| | - Suraj Abdulkarim
- SUFABEL Community Development Initiative, Gombe 760253, Nigeria;
| | - Thandi Katlholo
- Country and Community Support for Impact Team, Stop TB Partnership, 1218 Geneva, Switzerland; (T.K.); (C.S.)
| | - Caoimhe Smyth
- Country and Community Support for Impact Team, Stop TB Partnership, 1218 Geneva, Switzerland; (T.K.); (C.S.)
| | - Hunpiya Basason
- Janna Health Foundation, Yola 640231, Nigeria; (S.J.); (H.B.)
| | - Md. Toufiq Rahman
- Innovations & Grants Team, Stop TB Partnership, 1218 Geneva, Switzerland;
| | - Jacob Creswell
- Innovations & Grants Team, Stop TB Partnership, 1218 Geneva, Switzerland;
| |
Collapse
|
2
|
Eneogu RA, Mitchell EMH, Ogbudebe C, Aboki D, Anyebe V, Dimkpa CB, Egbule D, Nsa B, van der Grinten E, Soyinka FO, Abdur-Razzaq H, Useni S, Lawanson A, Onyemaechi S, Ubochioma E, Scholten J, Verhoef J, Nwadike P, Chukwueme N, Nongo D, Gidado M. Iterative evaluation of mobile computer-assisted digital chest x-ray screening for TB improves efficiency, yield, and outcomes in Nigeria. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002018. [PMID: 38232129 DOI: 10.1371/journal.pgph.0002018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024]
Abstract
Wellness on Wheels (WoW) is a model of mobile systematic tuberculosis (TB) screening of high-risk populations combining digital chest radiography with computer-aided automated detection (CAD) and chronic cough screening to identify presumptive TB clients in communities, health facilities, and prisons in Nigeria. The model evolves to address technical, political, and sustainability challenges. Screening methods were iteratively refined to balance TB yield and feasibility across heterogeneous populations. Performance metrics were compared over time. Screening volumes, risk mix, number needed to screen (NNS), number needed to test (NNT), sample loss, TB treatment initiation and outcomes. Efforts to mitigate losses along the diagnostic cascade were tracked. Persons with high CAD4TB score (≥80), who tested negative on a single spot GeneXpert were followed-up to assess TB status at six months. An experimental calibration method achieved a viable CAD threshold for testing. High risk groups and key stakeholders were engaged. Operations evolved in real time to fix problems. Incremental improvements in mean client volumes (128 to 140/day), target group inclusion (92% to 93%), on-site testing (84% to 86%), TB treatment initiation (87% to 91%), and TB treatment success (71% to 85%) were recorded. Attention to those as highest risk boosted efficiency (the NNT declined from 8.2 ± SD8.2 to 7.6 ± SD7.7). Clinical diagnosis was added after follow-up among those with ≥ 80 CAD scores and initially spot -sputum negative found 11 additional TB cases (6.3%) after 121 person-years of follow-up. Iterative adaptation in response to performance metrics foster feasible, acceptable, and efficient TB case-finding in Nigeria. High CAD scores can identify subclinical TB and those at risk of progression to bacteriologically-confirmed TB disease in the near term.
Collapse
Affiliation(s)
- Rupert A Eneogu
- United States Agency for International Development (USAID), Abuja, Nigeria
| | - Ellen M H Mitchell
- Mycobacterial Diseases and Neglected Tropical Diseases Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Danjuma Aboki
- Nasarawa State TB and Leprosy Control Program, Nasarawa, Nigeria
| | | | | | - Daniel Egbule
- Nasarawa State TB and Leprosy Control Program, Nasarawa, Nigeria
| | | | | | | | | | | | - Adebola Lawanson
- National TB and Leprosy Program, Federal Ministry of Health Nigeria, Abuja, Nigeria
| | - Simeon Onyemaechi
- National TB and Leprosy Program, Federal Ministry of Health Nigeria, Abuja, Nigeria
| | - Emperor Ubochioma
- National TB and Leprosy Program, Federal Ministry of Health Nigeria, Abuja, Nigeria
| | | | | | | | | | - Debby Nongo
- United States Agency for International Development (USAID), Abuja, Nigeria
| | | |
Collapse
|
3
|
de Groot LM, Dememew ZG, Hiruy N, Datiko DG, Gebreyes SN, Suarez PG, Jerene D. Effect of multicomponent interventions on tuberculosis notification in mining and pastoralist districts of Oromia region in Ethiopia: a longitudinal quasi-experimental study. BMJ Open 2023; 13:e071014. [PMID: 37188473 PMCID: PMC10186083 DOI: 10.1136/bmjopen-2022-071014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To demonstrate the impact of interventions on tuberculosis (TB) case detection in mining and pastoralist districts in southeastern Ethiopia over a 10-year period. DESIGN Longitudinal quasi-experimental study. SETTING Health centres and hospitals in six mining districts implemented interventions and seven nearby districts functioned as controls. PARTICIPANTS Data from the national District Health Information System (DHIS-2) were used for this study; therefore, people did not participate in this study. INTERVENTIONS Directed at training, active case finding and improving treatment outcomes. PRIMARY AND SECONDARY OUTCOME MEASURES Primarily, trends in TB case notification and percentage of bacteriologically confirmed TB-as collected by DHIS-2-between pre-intervention (2012-2015) and post-intervention (2016-2021) were analysed. Secondarily, post-intervention was split into early post-intervention (2016-2018) and late post-intervention (2019-2021) to also study the long-term effects of the intervention. RESULTS For all forms of TB, case notification significantly increased between pre-intervention and early post-intervention (incidence rate ratio (IRR): 1.21, 95% CI: 1.13, 1.31; p<0.001) and significantly decreased between pre-intervention/early post-intervention and late post-intervention (IRR: 0.82, 95% CI: 0.76, 0.89; p<0.001 and IRR: 0.67, 95% CI: 0.62, 0.73; p<0.001). For bacteriologically confirmed cases, we found a significant decrease between pre-intervention/early post-intervention and late post-intervention (IRR: 0.88, 95% CI: 0.81, 0.97; p<0.001 and IRR: 0.81, 95% CI: 0.74, 0.89; p<0.001). The percentage of bacteriologically confirmed cases was significantly lower in the intervention districts during pre-intervention (B: -14.24 percentage points, 95% CI: -19.27, -9.21) and early post-intervention (B: -7.78, 95% CI: -15.46, -0.010; p=0.047). From early post-intervention to late post-intervention, we found a significant increase (B: 9.12, 95% CI: 0.92 to 17.33; p=0.032). CONCLUSIONS The decrease in TB notifications in intervention districts during late post-intervention is possibly due to a decline in actual TB burden as a result of the interventions. The unabated increase in case notification in control districts may be due to continued TB transmission in the community.
Collapse
Affiliation(s)
- Liza Marlette de Groot
- Tuberculosis Elimination and Health Systems Innovation, KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | | | - Nebiyu Hiruy
- Management Sciences for Health Ethiopia, Addis Ababa, Ethiopia
| | | | | | - Pedro G Suarez
- Management Sciences for Health, Arlington, Virginia, USA
| | - Degu Jerene
- Tuberculosis Elimination and Health Systems Innovation, KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| |
Collapse
|
4
|
Anye LC, Agbortabot Bissong ME, Njundah AL, Siewe Fodjo JN. Depression, anxiety and medication adherence among tuberculosis patients attending treatment centres in Fako Division, Cameroon: cross-sectional study. BJPsych Open 2023; 9:e65. [PMID: 37051974 PMCID: PMC10134253 DOI: 10.1192/bjo.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Tuberculosis remains a public health problem, particularly in developing countries. Patients with tuberculosis often suffer from anxiety and depression, which is likely to affect adherence to the long course of tuberculosis treatment. AIMS This study sought to investigate depression, anxiety and medication adherence among Cameroonian tuberculosis patients. METHOD A cross-sectional study was conducted from March to June 2022 across five treatment centres in Fako Division, Southwest Region, Cameroon. Data were collected via face-to-face interviews with tuberculosis patients using a structured questionnaire. Sociodemographic information was obtained, and the following tools were administered to participants: the Hospital Anxiety and Depression Scale, the Oslo Social Support Scale, and the Medication Adherence Rating Scale. Multiple logistic regression models were fitted to investigate determinants of depression and anxiety. RESULTS A total of 375 participants were recruited (mean age: 35 ± 12.2 years; 60.5% male). The prevalence rates of depression and anxiety among tuberculosis patients were 47.7% and 29.9%, respectively. After adjusting for confounders, the odds of depression were significantly increased by having extrapulmonary tuberculosis, non-adherence to treatment, having no source of income, household size <5 and poor social support. Predictors for anxiety included extrapulmonary tuberculosis, defaulting tuberculosis treatment for ≥2 months, family history of mental illness, HIV/tuberculosis co-infection, being married, poor social support and non-adherence to treatment. CONCLUSIONS The prevalence of depression and anxiety in tuberculosis patients is relatively high, and diverse factors may be responsible. Therefore, holistic and comprehensive care for tuberculosis patients by mental health practitioners is highly encouraged, especially for the high-risk groups identified.
Collapse
|
5
|
Kay AW, Ness T, Verkuijl SE, Viney K, Brands A, Masini T, González Fernández L, Eisenhut M, Detjen AK, Mandalakas AM, Steingart KR, Takwoingi Y. Xpert MTB/RIF Ultra assay for tuberculosis disease and rifampicin resistance in children. Cochrane Database Syst Rev 2022; 9:CD013359. [PMID: 36065889 PMCID: PMC9446385 DOI: 10.1002/14651858.cd013359.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Every year, an estimated one million children and young adolescents become ill with tuberculosis, and around 226,000 of those children die. Xpert MTB/RIF Ultra (Xpert Ultra) is a molecular World Health Organization (WHO)-recommended rapid diagnostic test that simultaneously detects Mycobacterium tuberculosis complex and rifampicin resistance. We previously published a Cochrane Review 'Xpert MTB/RIF and Xpert MTB/RIF Ultra assays for tuberculosis disease and rifampicin resistance in children'. The current review updates evidence on the diagnostic accuracy of Xpert Ultra in children presumed to have tuberculosis disease. Parts of this review update informed the 2022 WHO updated guidance on management of tuberculosis in children and adolescents. OBJECTIVES To assess the diagnostic accuracy of Xpert Ultra for detecting: pulmonary tuberculosis, tuberculous meningitis, lymph node tuberculosis, and rifampicin resistance, in children with presumed tuberculosis. Secondary objectives To investigate potential sources of heterogeneity in accuracy estimates. For detection of tuberculosis, we considered age, comorbidity (HIV, severe pneumonia, and severe malnutrition), and specimen type as potential sources. To summarize the frequency of Xpert Ultra trace results. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, three other databases, and three trial registers without language restrictions to 9 March 2021. SELECTION CRITERIA Cross-sectional and cohort studies and randomized trials that evaluated Xpert Ultra in HIV-positive and HIV-negative children under 15 years of age. We included ongoing studies that helped us address the review objectives. We included studies evaluating sputum, gastric, stool, or nasopharyngeal specimens (pulmonary tuberculosis), cerebrospinal fluid (tuberculous meningitis), and fine needle aspirate or surgical biopsy tissue (lymph node tuberculosis). For detecting tuberculosis, reference standards were microbiological (culture) or composite reference standard; for stool, we also included Xpert Ultra performed on a routine respiratory specimen. For detecting rifampicin resistance, reference standards were drug susceptibility testing or MTBDRplus. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and, using QUADAS-2, assessed methodological quality judging risk of bias separately for each target condition and reference standard. For each target condition, we used the bivariate model to estimate summary sensitivity and specificity with 95% confidence intervals (CIs). We stratified all analyses by type of reference standard. We summarized the frequency of Xpert Ultra trace results; trace represents detection of a very low quantity of Mycobacterium tuberculosis DNA. We assessed certainty of evidence using GRADE. MAIN RESULTS We identified 14 studies (11 new studies since the previous review). For detection of pulmonary tuberculosis, 335 data sets (25,937 participants) were available for analysis. We did not identify any studies that evaluated Xpert Ultra accuracy for tuberculous meningitis or lymph node tuberculosis. Three studies evaluated Xpert Ultra for detection of rifampicin resistance. Ten studies (71%) took place in countries with a high tuberculosis burden based on WHO classification. Overall, risk of bias was low. Detection of pulmonary tuberculosis Sputum, 5 studies Xpert Ultra summary sensitivity verified by culture was 75.3% (95% CI 64.3 to 83.8; 127 participants; high-certainty evidence), and specificity was 97.1% (95% CI 94.7 to 98.5; 1054 participants; high-certainty evidence). Gastric aspirate, 7 studies Xpert Ultra summary sensitivity verified by culture was 70.4% (95% CI 53.9 to 82.9; 120 participants; moderate-certainty evidence), and specificity was 94.1% (95% CI 84.8 to 97.8; 870 participants; moderate-certainty evidence). Stool, 6 studies Xpert Ultra summary sensitivity verified by culture was 56.1% (95% CI 39.1 to 71.7; 200 participants; moderate-certainty evidence), and specificity was 98.0% (95% CI 93.3 to 99.4; 1232 participants; high certainty-evidence). Nasopharyngeal aspirate, 4 studies Xpert Ultra summary sensitivity verified by culture was 43.7% (95% CI 26.7 to 62.2; 46 participants; very low-certainty evidence), and specificity was 97.5% (95% CI 93.6 to 99.0; 489 participants; high-certainty evidence). Xpert Ultra sensitivity was lower against a composite than a culture reference standard for all specimen types other than nasopharyngeal aspirate, while specificity was similar against both reference standards. Interpretation of results In theory, for a population of 1000 children: • where 100 have pulmonary tuberculosis in sputum (by culture): - 101 would be Xpert Ultra-positive, and of these, 26 (26%) would not have pulmonary tuberculosis (false positive); and - 899 would be Xpert Ultra-negative, and of these, 25 (3%) would have tuberculosis (false negative). • where 100 have pulmonary tuberculosis in gastric aspirate (by culture): - 123 would be Xpert Ultra-positive, and of these, 53 (43%) would not have pulmonary tuberculosis (false positive); and - 877 would be Xpert Ultra-negative, and of these, 30 (3%) would have tuberculosis (false negative). • where 100 have pulmonary tuberculosis in stool (by culture): - 74 would be Xpert Ultra-positive, and of these, 18 (24%) would not have pulmonary tuberculosis (false positive); and - 926 would be Xpert Ultra-negative, and of these, 44 (5%) would have tuberculosis (false negative). • where 100 have pulmonary tuberculosis in nasopharyngeal aspirate (by culture): - 66 would be Xpert Ultra-positive, and of these, 22 (33%) would not have pulmonary tuberculosis (false positive); and - 934 would be Xpert Ultra-negative, and of these, 56 (6%) would have tuberculosis (false negative). Detection of rifampicin resistance Xpert Ultra sensitivity was 100% (3 studies, 3 participants; very low-certainty evidence), and specificity range was 97% to 100% (3 studies, 128 participants; low-certainty evidence). Trace results Xpert Ultra trace results, regarded as positive in children by WHO standards, were common. Xpert Ultra specificity remained high in children, despite the frequency of trace results. AUTHORS' CONCLUSIONS We found Xpert Ultra sensitivity to vary by specimen type, with sputum having the highest sensitivity, followed by gastric aspirate and stool. Nasopharyngeal aspirate had the lowest sensitivity. Xpert Ultra specificity was high against both microbiological and composite reference standards. However, the evidence base is still limited, and findings may be imprecise and vary by study setting. Although we found Xpert Ultra accurate for detection of rifampicin resistance, results were based on a very small number of studies that included only three children with rifampicin resistance. Therefore, findings should be interpreted with caution. Our findings provide support for the use of Xpert Ultra as an initial rapid molecular diagnostic in children being evaluated for tuberculosis.
Collapse
Key Words
- adolescent
- child
- humans
- antibiotics, antitubercular
- antibiotics, antitubercular/therapeutic use
- cross-sectional studies
- hiv infections
- hiv infections/drug therapy
- microbial sensitivity tests
- mycobacterium tuberculosis
- mycobacterium tuberculosis/genetics
- rifampin
- rifampin/pharmacology
- sensitivity and specificity
- sputum
- sputum/microbiology
- tuberculosis, lymph node
- tuberculosis, lymph node/diagnosis
- tuberculosis, lymph node/drug therapy
- tuberculosis, meningeal
- tuberculosis, meningeal/cerebrospinal fluid
- tuberculosis, meningeal/diagnosis
- tuberculosis, meningeal/drug therapy
- tuberculosis, pulmonary
- tuberculosis, pulmonary/diagnosis
- tuberculosis, pulmonary/drug therapy
- tuberculosis, pulmonary/microbiology
Collapse
Affiliation(s)
- Alexander W Kay
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Tara Ness
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Kerri Viney
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Annemieke Brands
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Tiziana Masini
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Lucia González Fernández
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Michael Eisenhut
- Paediatric Department, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | | | - Anna M Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
6
|
Naufal F, Chaisson LH, Robsky KO, Delgado-Barroso P, Alvarez-Manzo HS, Miller CR, Shapiro AE, Golub JE. Number needed to screen for TB in clinical, structural or occupational risk groups. Int J Tuberc Lung Dis 2022; 26:500-508. [PMID: 35650693 PMCID: PMC9202999 DOI: 10.5588/ijtld.21.0749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: Screening for active TB using active case-finding (ACF) may reduce TB incidence, prevalence, and mortality; however, yield of ACF interventions varies substantially across populations. We systematically reviewed studies reporting on ACF to calculate the number needed to screen (NNS) for groups at high risk for TB.METHODS: We conducted a literature search for studies reporting ACF for adults published between November 2010 and February 2020. We determined active TB prevalence detected through various screening strategies and calculated crude NNS for - TB confirmed using culture or Xpert® MTB/RIF, and weighted mean NNS stratified by screening strategy, risk group, and country-level TB incidence.RESULTS: We screened 27,223 abstracts; 90 studies were included (41 in low/moderate and 49 in medium/high TB incidence settings). High-risk groups included inpatients, outpatients, people living with diabetes (PLWD), migrants, prison inmates, persons experiencing homelessness (PEH), healthcare workers, and miners. Screening strategies included symptom-based screening, chest X-ray and Xpert testing. NNS varied widely across and within incidence settings based on risk groups and screening methods. Screening tools with higher sensitivity (e.g., Xpert, CXR) were associated with lower NNS estimates.CONCLUSIONS: NNS for ACF strategies varies substantially between adult risk groups. Specific interventions should be tailored based on local epidemiology and costs.
Collapse
Affiliation(s)
- F Naufal
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - L H Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - K O Robsky
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - P Delgado-Barroso
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - H S Alvarez-Manzo
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - C R Miller
- World Health Organization, Geneva, Switzerland
| | - A E Shapiro
- Departments of Global Health and Medicine, University of Washington, Seattle, WA
| | - J E Golub
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
7
|
Mohammed H, Oljira L, Roba KT, Ngadaya E, Manyazewal T, Ajeme T, Mnyambwa NP, Fekadu A, Yimer G. Tuberculosis Prevalence and Predictors Among Health Care-Seeking People Screened for Cough of Any Duration in Ethiopia: A Multicenter Cross-Sectional Study. Front Public Health 2022; 9:805726. [PMID: 35282420 PMCID: PMC8914016 DOI: 10.3389/fpubh.2021.805726] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) remains a major cause of morbidity and mortality in sub-Saharan Africa. This high burden is mainly attributed to low case detection and delayed diagnosis. We aimed to determine the prevalence and predictors of TB among health care-seeking people screened for cough of any duration in Ethiopia. Methods In this multicenter cross-sectional study, we screened 195,713 (81.2%) for cough of any duration. We recruited a sample of 1,853 presumptive TB (PTB) cases and assigned them into three groups: group I with cough ≥2 weeks, group II with cough of <2 weeks, and group III pregnant women, patients on antiretroviral therapy, and patients with diabetes. The first two groups underwent chest radiograph (CXR) followed by sputum Xpert MTB/RIF assay or smear microscopy. The third group was exempted from CXR but underwent sputum Xpert MTB/RIF assay or smear microscopy. TB prevalence was calculated across the groups and TB predictors were analyzed using modified Poisson regression to compute adjusted prevalence ratio (aPR) with a 95% confidence interval (CI). Results The overall prevalence of PTB was 16.7% (309/1853). Of the positive cases, 81.2% (251/309) were in group I (cough ≥2 weeks), 14.2% (44/309) in group II (cough of <2), and 4.5% (14/309) in group III (CXR exempted). PTB predictors were age group of 25-34 [aPR = 2.0 (95% CI 1.3-2.8)], history of weight loss [aPR = 1.2 (95% CI 1.1-1.3)], and TB suggestive CXRs [aPR = 41.1 (95% CI 23.2-72.8)]. Conclusion The prevalence of confirmed PTB among routine outpatients was high, and this included those with a low duration of cough who can serve as a source of infection. Screening all patients at outpatient departments who passively report any cough irrespective of duration is important to increase TB case finding and reduce TB transmission and mortality.
Collapse
Affiliation(s)
- Hussen Mohammed
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tigest Ajeme
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nicholaus P. Mnyambwa
- Muhimbili Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Getnet Yimer
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ohio State Global One Health Initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
| |
Collapse
|
8
|
Adamou Mana Z, Beaudou CN, Hilaire KFJ, Konso J, Ndahbove C, Waindim Y, Ganava M, Malama T, Matip C, Meoto P, Wandji IAG, Fundoh M, Mbuli C, Comfort V, Teyim P, Alba S, Creswell J, Mbassa V, Sander M. Impact of intensified tuberculosis case finding at health facilities on case notifications in Cameroon: A controlled interrupted time series analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000301. [PMID: 36962183 PMCID: PMC10021155 DOI: 10.1371/journal.pgph.0000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/23/2022] [Indexed: 11/18/2022]
Abstract
There is a large gap between the number of people who develop tuberculosis (TB) and those who are diagnosed, treated and notified, with only an estimated 71% of people with TB notified globally in 2019. Implementing better TB case finding strategies is necessary to close this gap. In Cameroon, 1,597 healthcare workers at 725 health facilities were trained and engaged to intensively screen and test people for TB, then follow-up to link people to appropriate care. Primary care centers were linked to TB testing through a locally-tailored specimen referral network. This intervention was implemented across 6 regions of the country, with a population of 16 million people, while the remaining 4 regions in the country, with 7.3 million people, served as a control area. Controlled interrupted time series analyses were used to compare routinely-collected programmatic TB case notification rates in the intervention versus control area for 12 quarters prior to (2016-2018) and for 8 quarters after the start of the intervention (2019-2020). In 2019-2020, a total of 167,508 people were tested for TB at intervention sites, including 52,980 people attending primary care facilities that did not previously provide organized TB services. The number of people tested for TB increased by 45% during the intervention as compared to prior to the intervention. The controlled interrupted time series analyses showed that after two years of the intervention, the all-forms TB case notification rate in the intervention population increased by 9% (ratio of case notification rate ratios = 1.09, 95% CI 1.06 to 1.12), as compared with the counterfactual estimated from pre-intervention trends. This increase was observed even during a negative national impact on case finding from the COVID-19 pandemic. These results support the use of this health-facility based intervention to improve access to TB testing and care in this setting.
Collapse
Affiliation(s)
| | | | | | - Joceline Konso
- Center for Health Promotion and Research, Bamenda, Northwest, Cameroon
| | - Carole Ndahbove
- Center for Health Promotion and Research, Bamenda, Northwest, Cameroon
| | - Yvonne Waindim
- Center for Health Promotion and Research, Bamenda, Northwest, Cameroon
| | - Maurice Ganava
- National TB Program- Far North Region, Maroua, Far North, Cameroon
| | | | | | - Paul Meoto
- National TB Program- Southwest Region, Buea, Southwest, Cameroon
| | | | - Mercy Fundoh
- National TB Program- Northwest Region, Bamenda, Northwest, Cameroon
| | - Cyrille Mbuli
- Center for Health Promotion and Research, Bamenda, Northwest, Cameroon
| | - Vuchas Comfort
- Center for Health Promotion and Research, Bamenda, Northwest, Cameroon
| | - Pride Teyim
- Tuberculosis Reference Laboratory Douala, Douala, Littoral, Cameroon
| | - Sandra Alba
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | | | | | - Melissa Sander
- Center for Health Promotion and Research, Bamenda, Northwest, Cameroon
| |
Collapse
|
9
|
Independent evaluation of 12 artificial intelligence solutions for the detection of tuberculosis. Sci Rep 2021; 11:23895. [PMID: 34903808 PMCID: PMC8668935 DOI: 10.1038/s41598-021-03265-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
There have been few independent evaluations of computer-aided detection (CAD) software for tuberculosis (TB) screening, despite the rapidly expanding array of available CAD solutions. We developed a test library of chest X-ray (CXR) images which was blindly re-read by two TB clinicians with different levels of experience and then processed by 12 CAD software solutions. Using Xpert MTB/RIF results as the reference standard, we compared the performance characteristics of each CAD software against both an Expert and Intermediate Reader, using cut-off thresholds which were selected to match the sensitivity of each human reader. Six CAD systems performed on par with the Expert Reader (Qure.ai, DeepTek, Delft Imaging, JF Healthcare, OXIPIT, and Lunit) and one additional software (Infervision) performed on par with the Intermediate Reader only. Qure.ai, Delft Imaging and Lunit were the only software to perform significantly better than the Intermediate Reader. The majority of these CAD software showed significantly lower performance among participants with a past history of TB. The radiography equipment used to capture the CXR image was also shown to affect performance for some CAD software. TB program implementers now have a wide selection of quality CAD software solutions to utilize in their CXR screening initiatives.
Collapse
|
10
|
Govender I, Karat AS, Olivier S, Baisley K, Beckwith P, Dayi N, Dreyer J, Gareta D, Gunda R, Kielmann K, Koole O, Mhlongo N, Modise T, Moodley S, Mpofana X, Ndung'u T, Pillay D, Siedner MJ, Smit T, Surujdeen A, Wong EB, Grant AD. Prevalence of Mycobacterium tuberculosis in sputum and reported symptoms among clinic attendees compared to a community survey in rural South Africa. Clin Infect Dis 2021; 75:314-322. [PMID: 34864910 PMCID: PMC9410725 DOI: 10.1093/cid/ciab970] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) case finding efforts typically target symptomatic people attending health facilities. We compared the prevalence of Mycobacterium tuberculosis (Mtb) sputum culture-positivity among adult clinic attendees in rural South Africa with a concurrent, community-based estimate from the surrounding demographic surveillance area (DSA). METHODS Clinic: Randomly-selected adults (≥18 years) attending two primary healthcare clinics were interviewed and requested to give sputum for mycobacterial culture. HIV and antiretroviral therapy (ART) status were based on self-report and record review. Community: All adult (≥15 years) DSA residents were invited to a mobile clinic for health screening, including serological HIV testing; those with ≥1 TB symptom (cough, weight loss, night sweats, fever) or abnormal chest radiograph were asked for sputum. RESULTS Clinic: 2,055 patients were enrolled (76.9% female, median age 36 years); 1,479 (72.0%) were classified HIV-positive (98.9% on ART) and 131 (6.4%) reported ≥1 TB symptom. Of 20/2,055 (1.0% [95% CI 0.6-1.5]) with Mtb culture-positive sputum, 14 (70%) reported no symptoms. Community: 10,320 residents were enrolled (68.3% female, median age 38 years); 3,105 (30.3%) tested HIV-positive (87.4% on ART) and 1,091 (10.6%) reported ≥1 TB symptom. Of 58/10,320 (0.6% [95% CI 0.4-0.7]) with Mtb culture-positive sputum, 45 (77.6%) reported no symptoms.In both surveys, sputum culture positivity was associated with male sex and reporting >1 TB symptom. CONCLUSIONS In both clinic and community settings, most participants with Mtb culture-positive sputum were asymptomatic. TB screening based only on symptoms will miss many people with active disease in both settings.
Collapse
Affiliation(s)
- Indira Govender
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Aaron S Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen Olivier
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Kathy Baisley
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peter Beckwith
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Njabulo Dayi
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Jaco Dreyer
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Dickman Gareta
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Resign Gunda
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Olivier Koole
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Ngcebo Mhlongo
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Tshwaraganang Modise
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Sashen Moodley
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Xolile Mpofana
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Thumbi Ndung'u
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa.,School of Public Health, Harvard Medical School, Boston, United States of America
| | - Deenan Pillay
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa.,Division of Infection & Immunity, University College London, London, United Kingdom
| | - Mark J Siedner
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, United States of America
| | - Theresa Smit
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Ashmika Surujdeen
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa
| | - Emily B Wong
- Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa.,Division of Infection & Immunity, University College London, London, United Kingdom.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, United States of America.,Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, United States of America.,Division of Infection and Immunity, University College London, London, United Kingdom
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Clinical Research Department, Africa Health Research Institute, Somkhele, South Africa.,School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | |
Collapse
|
11
|
Pande T, Vasquez NA, Cazabon D, Creswell J, Brouwer M, Ramis O, Stevens RH, Ananthakrishnan R, Qayyum S, Alphonsus C, Oga-Omenka C, Nafade V, Sen P, Pai M. Finding the missing millions: lessons from 10 active case finding interventions in high tuberculosis burden countries. BMJ Glob Health 2021; 5:bmjgh-2020-003835. [PMID: 33355269 PMCID: PMC7757499 DOI: 10.1136/bmjgh-2020-003835] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/28/2020] [Accepted: 12/03/2020] [Indexed: 01/28/2023] Open
Affiliation(s)
- Tripti Pande
- McGill University Health Centre, Montreal, Québec, Canada
| | | | - Danielle Cazabon
- Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada
| | | | | | | | | | - Ramya Ananthakrishnan
- Resource group for Education and Advocacy for Community Health (REACH), Chennai, India
| | | | | | | | - Vaidehi Nafade
- Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada
| | - Paulami Sen
- Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada
| | - Madhukar Pai
- Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada.,Manipal McGill Program in Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
12
|
Nguyen LH, Codlin AJ, Vo LNQ, Dao T, Tran D, Forse RJ, Vu TN, Le GT, Luu T, Do GC, Truong VV, Minh HDT, Nguyen HH, Creswell J, Caws M, Nguyen HB, Nguyen NV. An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam. Trop Med Infect Dis 2020; 5:tropicalmed5040185. [PMID: 33321696 PMCID: PMC7768495 DOI: 10.3390/tropicalmed5040185] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023] Open
Abstract
Across Asia, a large proportion of people with tuberculosis (TB) do not report symptoms, have mild symptoms or only experience symptoms for a short duration. These individuals may not seek care at health facilities or may be missed by symptom screening, resulting in sustained TB transmission in the community. We evaluated the yields of TB from 114 days of community-based, mobile chest X-ray (CXR) screening. The yields at each step of the TB screening cascade were tabulated and we compared cohorts of participants who reported having a prolonged cough and those reporting no cough or one of short duration. We estimated the marginal yields of TB using different diagnostic algorithms and calculated the relative diagnostic costs and cost per case for each algorithm. A total of 34,529 participants were screened by CXR, detecting 256 people with Xpert-positive TB. Only 50% of those diagnosed with TB were detected among participants reporting a prolonged cough. The study’s screening algorithm detected almost 4 times as much TB as the National TB Program’s standard diagnostic algorithm. Community-based, mobile chest X-ray screening can be a high yielding strategy which is able to identify people with TB who would likely otherwise have been missed by existing health services.
Collapse
Affiliation(s)
- Lan Huu Nguyen
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700 000, Vietnam; (L.H.N.); (G.C.D.); (V.V.T.); (H.D.T.M.)
| | - Andrew J. Codlin
- Friends for International TB Relief, Ho Chi Minh City 700 000, Vietnam; (L.N.Q.V.); (D.T.); (R.J.F.)
- Correspondence: ; Tel.: +84-352512847
| | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Ho Chi Minh City 700 000, Vietnam; (L.N.Q.V.); (D.T.); (R.J.F.)
- Interactive Research and Development, Singapore 238884, Singapore
| | - Thang Dao
- IRD VN, Ho Chi Minh City 700 000, Vietnam;
| | - Duc Tran
- Friends for International TB Relief, Ho Chi Minh City 700 000, Vietnam; (L.N.Q.V.); (D.T.); (R.J.F.)
| | - Rachel J. Forse
- Friends for International TB Relief, Ho Chi Minh City 700 000, Vietnam; (L.N.Q.V.); (D.T.); (R.J.F.)
| | - Thanh Nguyen Vu
- Ho Chi Minh City Public Health Association, Ho Chi Minh City 700 000, Vietnam; (T.N.V.); (G.T.L.)
| | - Giang Truong Le
- Ho Chi Minh City Public Health Association, Ho Chi Minh City 700 000, Vietnam; (T.N.V.); (G.T.L.)
| | - Tuan Luu
- Clinton Health Access Initiative Vietnam, Ha Noi 100 000, Vietnam;
| | - Giang Chau Do
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700 000, Vietnam; (L.H.N.); (G.C.D.); (V.V.T.); (H.D.T.M.)
| | - Vinh Van Truong
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700 000, Vietnam; (L.H.N.); (G.C.D.); (V.V.T.); (H.D.T.M.)
| | - Ha Dang Thi Minh
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700 000, Vietnam; (L.H.N.); (G.C.D.); (V.V.T.); (H.D.T.M.)
| | - Hung Huu Nguyen
- Ho Chi Minh City Department of Health, Ho Chi Minh City 700 000, Vietnam;
| | | | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
- Birat Nepal Medical Trust Nepal, Kathmandu 44600, Nepal
| | - Hoa Binh Nguyen
- Viet Nam National Lung Hospital, Ha Noi 100 000, Vietnam; (H.B.N.); (N.V.N.)
| | - Nhung Viet Nguyen
- Viet Nam National Lung Hospital, Ha Noi 100 000, Vietnam; (H.B.N.); (N.V.N.)
| |
Collapse
|
13
|
Kay AW, González Fernández L, Takwoingi Y, Eisenhut M, Detjen AK, Steingart KR, Mandalakas AM. Xpert MTB/RIF and Xpert MTB/RIF Ultra assays for active tuberculosis and rifampicin resistance in children. Cochrane Database Syst Rev 2020; 8:CD013359. [PMID: 32853411 PMCID: PMC8078611 DOI: 10.1002/14651858.cd013359.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Every year, at least one million children become ill with tuberculosis and around 200,000 children die. Xpert MTB/RIF and Xpert Ultra are World Health Organization (WHO)-recommended rapid molecular tests that simultaneously detect tuberculosis and rifampicin resistance in adults and children with signs and symptoms of tuberculosis, at lower health system levels. To inform updated WHO guidelines on molecular assays, we performed a systematic review on the diagnostic accuracy of these tests in children presumed to have active tuberculosis. OBJECTIVES Primary objectives • To determine the diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for (a) pulmonary tuberculosis in children presumed to have tuberculosis; (b) tuberculous meningitis in children presumed to have tuberculosis; (c) lymph node tuberculosis in children presumed to have tuberculosis; and (d) rifampicin resistance in children presumed to have tuberculosis - For tuberculosis detection, index tests were used as the initial test, replacing standard practice (i.e. smear microscopy or culture) - For detection of rifampicin resistance, index tests replaced culture-based drug susceptibility testing as the initial test Secondary objectives • To compare the accuracy of Xpert MTB/RIF and Xpert Ultra for each of the four target conditions • To investigate potential sources of heterogeneity in accuracy estimates - For tuberculosis detection, we considered age, disease severity, smear-test status, HIV status, clinical setting, specimen type, high tuberculosis burden, and high tuberculosis/HIV burden - For detection of rifampicin resistance, we considered multi-drug-resistant tuberculosis burden • To compare multiple Xpert MTB/RIF or Xpert Ultra results (repeated testing) with the initial Xpert MTB/RIF or Xpert Ultra result SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and the International Standard Randomized Controlled Trials Number (ISRCTN) Registry up to 29 April 2019, without language restrictions. SELECTION CRITERIA Randomized trials, cross-sectional trials, and cohort studies evaluating Xpert MTB/RIF or Xpert Ultra in HIV-positive and HIV-negative children younger than 15 years. Reference standards comprised culture or a composite reference standard for tuberculosis and drug susceptibility testing or MTBDRplus (molecular assay for detection of Mycobacterium tuberculosis and drug resistance) for rifampicin resistance. We included studies evaluating sputum, gastric aspirate, stool, nasopharyngeal or bronchial lavage specimens (pulmonary tuberculosis), cerebrospinal fluid (tuberculous meningitis), fine needle aspirates, or surgical biopsy tissue (lymph node tuberculosis). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality using the Quality Assessment of Studies of Diagnostic Accuracy - Revised (QUADAS-2). For each target condition, we used the bivariate model to estimate pooled sensitivity and specificity with 95% confidence intervals (CIs). We stratified all analyses by type of reference standard. We assessed certainty of evidence using the GRADE approach. MAIN RESULTS For pulmonary tuberculosis, 299 data sets (68,544 participants) were available for analysis; for tuberculous meningitis, 10 data sets (423 participants) were available; for lymph node tuberculosis, 10 data sets (318 participants) were available; and for rifampicin resistance, 14 data sets (326 participants) were available. Thirty-nine studies (80%) took place in countries with high tuberculosis burden. Risk of bias was low except for the reference standard domain, for which risk of bias was unclear because many studies collected only one specimen for culture. Detection of pulmonary tuberculosis For sputum specimens, Xpert MTB/RIF pooled sensitivity (95% CI) and specificity (95% CI) verified by culture were 64.6% (55.3% to 72.9%) (23 studies, 493 participants; moderate-certainty evidence) and 99.0% (98.1% to 99.5%) (23 studies, 6119 participants; moderate-certainty evidence). For other specimen types (nasopharyngeal aspirate, 4 studies; gastric aspirate, 14 studies; stool, 11 studies), Xpert MTB/RIF pooled sensitivity ranged between 45.7% and 73.0%, and pooled specificity ranged between 98.1% and 99.6%. For sputum specimens, Xpert Ultra pooled sensitivity (95% CI) and specificity (95% CI) verified by culture were 72.8% (64.7% to 79.6%) (3 studies, 136 participants; low-certainty evidence) and 97.5% (95.8% to 98.5%) (3 studies, 551 participants; high-certainty evidence). For nasopharyngeal specimens, Xpert Ultra sensitivity (95% CI) and specificity (95% CI) were 45.7% (28.9% to 63.3%) and 97.5% (93.7% to 99.3%) (1 study, 195 participants). For all specimen types, Xpert MTB/RIF and Xpert Ultra sensitivity were lower against a composite reference standard than against culture. Detection of tuberculous meningitis For cerebrospinal fluid, Xpert MTB/RIF pooled sensitivity and specificity, verified by culture, were 54.0% (95% CI 27.8% to 78.2%) (6 studies, 28 participants; very low-certainty evidence) and 93.8% (95% CI 84.5% to 97.6%) (6 studies, 213 participants; low-certainty evidence). Detection of lymph node tuberculosis For lymph node aspirates or biopsies, Xpert MTB/RIF pooled sensitivity and specificity, verified by culture, were 90.4% (95% CI 55.7% to 98.6%) (6 studies, 68 participants; very low-certainty evidence) and 89.8% (95% CI 71.5% to 96.8%) (6 studies, 142 participants; low-certainty evidence). Detection of rifampicin resistance Xpert MTB/RIF pooled sensitivity and specificity were 90.0% (67.6% to 97.5%) (6 studies, 20 participants; low-certainty evidence) and 98.3% (87.7% to 99.8%) (6 studies, 203 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS We found Xpert MTB/RIF sensitivity to vary by specimen type, with gastric aspirate specimens having the highest sensitivity followed by sputum and stool, and nasopharyngeal specimens the lowest; specificity in all specimens was > 98%. Compared with Xpert MTB/RIF, Xpert Ultra sensitivity in sputum was higher and specificity slightly lower. Xpert MTB/RIF was accurate for detection of rifampicin resistance. Xpert MTB/RIF was sensitive for diagnosing lymph node tuberculosis. For children with presumed tuberculous meningitis, treatment decisions should be based on the entirety of clinical information and treatment should not be withheld based solely on an Xpert MTB/RIF result. The small numbers of studies and participants, particularly for Xpert Ultra, limits our confidence in the precision of these estimates.
Collapse
MESH Headings
- Adolescent
- Antibiotics, Antitubercular/therapeutic use
- Bias
- Child
- Feces/microbiology
- Gastrointestinal Contents/microbiology
- Humans
- Molecular Typing/methods
- Molecular Typing/standards
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/isolation & purification
- Rifampin/therapeutic use
- Sensitivity and Specificity
- Sputum/microbiology
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/microbiology
- Tuberculosis, Meningeal/cerebrospinal fluid
- Tuberculosis, Meningeal/diagnosis
- Tuberculosis, Meningeal/drug therapy
- Tuberculosis, Meningeal/microbiology
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/microbiology
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/microbiology
Collapse
Affiliation(s)
- Alexander W Kay
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael Eisenhut
- Paediatric Department, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | | | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anna M Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
14
|
José B, Manhiça I, Jones J, Mutaquiha C, Zindoga P, Eduardo I, Creswell J, Qin ZZ, Ramis O, Ramiro I, Chidacua M, Cowan J. Using community health workers for facility and community based TB case finding: An evaluation in central Mozambique. PLoS One 2020; 15:e0236262. [PMID: 32702073 PMCID: PMC7377411 DOI: 10.1371/journal.pone.0236262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mozambique has one of the highest incidence rates of both TB and HIV in the world and an estimated tuberculosis (TB) treatment coverage of only 57% in 2018. Numerous approaches are being tested to reduce existing gaps in coverage and the estimated number of missing cases. METHODS Thirty Community Healthcare Workers (CHWs) were tasked with increasing TB notifications by performing verbal facility-based TB screening of all people presenting for care and TB contact tracing in the community. Using routine National TB Program data, we analyzed trends in TB notifications in five intervention districts and seven control districts in Manica province the year before this project and during a one-year intervention period. RESULTS In the four quarters before the study, the intervention districts notified 5,219 individuals with all forms of TB, and the control districts notified 2,248 TB cases. During the study 5,982 all forms of people with TB were notified in the intervention area, an increase of 763 (14.6%) over the baseline, whereas the control districts notified 1,877 persons with TB, a decrease of -371 (-16.5%). The CHW screening activities yielded 1,502 notified and treated individuals with TB. CONCLUSIONS Employing CHWs to promote facility-based TB screening and household contact tracing may lead to an overall increase in TB notification.
Collapse
Affiliation(s)
- B. José
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - I. Manhiça
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - J. Jones
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - C. Mutaquiha
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - P. Zindoga
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - I. Eduardo
- Provincial TB Program, Mozambique Ministry of Health, Manica, Mozambique
| | - J. Creswell
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - Z. Z. Qin
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - O. Ramis
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - I. Ramiro
- Health Alliance International, Beira, Mozambique
| | - M. Chidacua
- Health Alliance International, Beira, Mozambique
| | - J. Cowan
- Health Alliance International, Beira, Mozambique
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| |
Collapse
|
15
|
Shi Q, Wang J, Yang Z, Liu Y. CircAGFG1modulates autophagy and apoptosis of macrophages infected by Mycobacterium tuberculosis via the Notch signaling pathway. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:645. [PMID: 32566582 PMCID: PMC7290638 DOI: 10.21037/atm.2020-20-3048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent studies have revealed the involvement of circular RNAs (circRNAs) in the control and elimination of invading Mycobacterium tuberculosis (Mtb) by macrophages. However, the regulatory mechanism of circAGFG1 in macrophages infected by Mtb has not been fully explored. In this study, we sought to investigate the role of circAGFG1 on autophagy and apoptosis of Mtb-infected macrophages and reveal its the molecular mechanism. Methods The expression of circAGFG1 in macrophages from patients with active tuberculosis and in Mtb-treated macrophages in vitro was explored. Then, the effect of circAGFG1 on autophagy and apoptosis of Mtb-infected macrophages was evaluated by flow cytometry, electron microscope, immunofluorescence, and Western blotting. Bioinformatics analysis was used to identify and validate the downstream regulatory pathway of circAGFG1, miRNA-1257/Notch. For further analysis, the role of miRNA-1257 on autophagy and apoptosis was assessed. Results In vitro, ectopic expression of circAGFG1 upregulated autophagy and reduced apoptosis significantly in Mtb-infected cells. Notch levels were discovered to be increased by the silencing effect of circAGFG1 on miRNA-1257 expression. miRNA-1257 was found to noticeably reduce autophagy and promote macrophage apoptosis. Increased circAGFG1 expression, decreased monocyte apoptosis, and enhanced autophagy were found in macrophages from patients with active tuberculosis. Conclusions In active tuberculosis, circAGFG1 enhances autophagy and reduces apoptosis via the miRNA-1257/Notch axis; this provides new therapeutic targets for tuberculosis patients.
Collapse
Affiliation(s)
- Qinghong Shi
- Department of Clinical Laboratory, The Third Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Jingying Wang
- Department of Clinical Laboratory, The Third Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Zhe Yang
- Department of Radiological, The Second hospital of Jilin University, Changchun 130021, China
| | - Yang Liu
- Department of Radiological, The Second hospital of Jilin University, Changchun 130021, China
| |
Collapse
|
16
|
Qin ZZ, Sander MS, Rai B, Titahong CN, Sudrungrot S, Laah SN, Adhikari LM, Carter EJ, Puri L, Codlin AJ, Creswell J. Using artificial intelligence to read chest radiographs for tuberculosis detection: A multi-site evaluation of the diagnostic accuracy of three deep learning systems. Sci Rep 2019; 9:15000. [PMID: 31628424 PMCID: PMC6802077 DOI: 10.1038/s41598-019-51503-3] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/01/2019] [Indexed: 11/08/2022] Open
Abstract
Deep learning (DL) neural networks have only recently been employed to interpret chest radiography (CXR) to screen and triage people for pulmonary tuberculosis (TB). No published studies have compared multiple DL systems and populations. We conducted a retrospective evaluation of three DL systems (CAD4TB, Lunit INSIGHT, and qXR) for detecting TB-associated abnormalities in chest radiographs from outpatients in Nepal and Cameroon. All 1196 individuals received a Xpert MTB/RIF assay and a CXR read by two groups of radiologists and the DL systems. Xpert was used as the reference standard. The area under the curve of the three systems was similar: Lunit (0.94, 95% CI: 0.93-0.96), qXR (0.94, 95% CI: 0.92-0.97) and CAD4TB (0.92, 95% CI: 0.90-0.95). When matching the sensitivity of the radiologists, the specificities of the DL systems were significantly higher except for one. Using DL systems to read CXRs could reduce the number of Xpert MTB/RIF tests needed by 66% while maintaining sensitivity at 95% or better. Using a universal cutoff score resulted different performance in each site, highlighting the need to select scores based on the population screened. These DL systems should be considered by TB programs where human resources are constrained, and automated technology is available.
Collapse
Affiliation(s)
- Zhi Zhen Qin
- Stop TB Partnership, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland
| | - Melissa S Sander
- Tuberculosis Reference Laboratory Bamenda, PO Box 586, Bamenda, Cameroon
| | - Bishwa Rai
- International Organization for Migration, Migration Health Department, Kathmandu, Nepal
| | - Collins N Titahong
- Tuberculosis Reference Laboratory Bamenda, PO Box 586, Bamenda, Cameroon
| | - Santat Sudrungrot
- International Organization for Migration, Migration Health Department, Kathmandu, Nepal
| | - Sylvain N Laah
- Tuberculosis Reference Laboratory Bamenda, PO Box 586, Bamenda, Cameroon
- Bamenda Regional Hospital, PO Box 818, Bamenda, Cameroon
| | - Lal Mani Adhikari
- International Organization for Migration, Migration Health Department, Kathmandu, Nepal
| | - E Jane Carter
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep, Warren Alpert Medical School, Brown University, Rhode Island, USA
| | - Lekha Puri
- Stop TB Partnership, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland
| | - Andrew J Codlin
- Stop TB Partnership, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland
| | - Jacob Creswell
- Stop TB Partnership, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Geneva, Switzerland.
| |
Collapse
|