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Wang CH, Chang W, Lee MR, Tay J, Wu CY, Wu MC, Roth HR, Yang D, Zhao C, Wang W, Huang CH. Deep Learning-based Diagnosis of Pulmonary Tuberculosis on Chest X-ray in the Emergency Department: A Retrospective Study. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:589-600. [PMID: 38343228 PMCID: PMC11031502 DOI: 10.1007/s10278-023-00952-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 04/20/2024]
Abstract
Prompt and correct detection of pulmonary tuberculosis (PTB) is critical in preventing its spread. We aimed to develop a deep learning-based algorithm for detecting PTB on chest X-ray (CXRs) in the emergency department. This retrospective study included 3498 CXRs acquired from the National Taiwan University Hospital (NTUH). The images were chronologically split into a training dataset, NTUH-1519 (images acquired during the years 2015 to 2019; n = 2144), and a testing dataset, NTUH-20 (images acquired during the year 2020; n = 1354). Public databases, including the NIH ChestX-ray14 dataset (model training; 112,120 images), Montgomery County (model testing; 138 images), and Shenzhen (model testing; 662 images), were also used in model development. EfficientNetV2 was the basic architecture of the algorithm. Images from ChestX-ray14 were employed for pseudo-labelling to perform semi-supervised learning. The algorithm demonstrated excellent performance in detecting PTB (area under the receiver operating characteristic curve [AUC] 0.878, 95% confidence interval [CI] 0.854-0.900) in NTUH-20. The algorithm showed significantly better performance in posterior-anterior (PA) CXR (AUC 0.940, 95% CI 0.912-0.965, p-value < 0.001) compared with anterior-posterior (AUC 0.782, 95% CI 0.644-0.897) or portable anterior-posterior (AUC 0.869, 95% CI 0.814-0.918) CXR. The algorithm accurately detected cases of bacteriologically confirmed PTB (AUC 0.854, 95% CI 0.823-0.883). Finally, the algorithm tested favourably in Montgomery County (AUC 0.838, 95% CI 0.765-0.904) and Shenzhen (AUC 0.806, 95% CI 0.771-0.839). A deep learning-based algorithm could detect PTB on CXR with excellent performance, which may help shorten the interval between detection and airborne isolation for patients with PTB.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Weishan Chang
- Department of Mathematics, National Taiwan University, Taipei, Taiwan
| | - Meng-Rui Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Joyce Tay
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Meng-Che Wu
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei City, 100, Taiwan
| | | | - Dong Yang
- NVIDIA Corporation, Bethesda, MD, USA
| | - Can Zhao
- NVIDIA Corporation, Bethesda, MD, USA
| | - Weichung Wang
- Institute of Applied Mathematical Sciences, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei, 106, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei City, 100, Taiwan.
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Müller A, Osório C, Figueiredo R, Silva D, Dalcin P. Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study. Braz J Med Biol Res 2023; 56:e12236. [PMID: 36722657 PMCID: PMC9883006 DOI: 10.1590/1414-431x2023e12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/30/2022] [Indexed: 01/31/2023] Open
Abstract
Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index.
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Affiliation(s)
- A.M. Müller
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - C.S. Osório
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - R.V. Figueiredo
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - D.R. Silva
- Programa de Pós-Graduação em Ciências Pneumológicas, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - P.T.R. Dalcin
- Programa de Pós-Graduação em Ciências Pneumológicas, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Migliori GB, Thong PM, Alffenaar JW, Denholm J, Tadolini M, Alyaquobi F, Al-Abri S, Blanc FX, Buonsenso D, Chakaya J, Cho JG, Codecasa LR, Danila E, Duarte R, Dukpa R, García-García JM, Gualano G, Kurhasani X, Manika K, Mello FCDQ, Pahl K, Rendon A, Sotgiu G, Souleymane MB, Thomas TA, Tiberi S, Kunst H, Udwadia ZF, Goletti D, Centis R, D’Ambrosio L, Silva DR. Country-specific lockdown measures in response to the COVID-19 pandemic and its impact on tuberculosis control: a global study. J Bras Pneumol 2022; 48:e20220087. [PMID: 35475873 PMCID: PMC9064628 DOI: 10.36416/1806-3756/e20220087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to describe country-specific lockdown measures and tuberculosis indicators collected during the first year of the COVID-19 pandemic. Data on lockdown/social restrictions (compulsory face masks and hand hygiene; international and local travel restrictions; restrictions to family visits, and school closures) were collected from 24 countries spanning five continents. The majority of the countries implemented multiple lockdowns with partial or full reopening. There was an overall decrease in active tuberculosis, drug-resistant tuberculosis, and latent tuberculosis cases. Although national lockdowns were effective in containing COVID-19 cases, several indicators of tuberculosis were affected during the pandemic.
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Affiliation(s)
| | - Pei Min Thong
- . National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jan-Willem Alffenaar
- . The University of Sydney, Pharmacy School, Sydney (NSW) Australia
- . The University of Sidney at Westmead Hospital, Sydney (NSW) Australia
- . Sydney Institute for Infectious Diseases, The University of Sydney, Sydney (NSW) Australia
| | - Justin Denholm
- . Melbourne Health Victorian Tuberculosis Program, Melbourne (VIC) Australia
- . Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne (VIC) Australia
| | - Marina Tadolini
- . Infectious Diseases Unit, Istituti Clinici Scientifici Maugeri - IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italia
- . Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fatma Alyaquobi
- . TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control, National TB Programme, MoH Oman, Muscat, Sultanate of Oman
| | - Seif Al-Abri
- . Directorate General for Disease Surveillance and Control, MoH Oman, Muscat, Sultanate of Oman
| | - François-Xavier Blanc
- . Nantes Université, CHU Nantes, Service de Pneumologie, L’Institut du Thorax, Nantes, France
| | - Danilo Buonsenso
- . Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli - IRCCS - Roma, Italia
| | - Jeremiah Chakaya
- . Department of Medicine, Dermatology and Therapeutics, Kenyatta University, Nairobi, Kenya
- . Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jin-Gun Cho
- . The University of Sidney at Westmead Hospital, Sydney (NSW) Australia
- . Parramatta Chest Clinic, Parramatta (NSW) Australia
| | - Luigi Ruffo Codecasa
- . TB Reference Centre of Villa Marelli Institute, Niguarda Hospital, Milano, Italia
| | - Edvardas Danila
- . Vilnius University Hospital Santaros Kilinkos, Vilinius, Lithuania
| | - Raquel Duarte
- . National Reference Centre for MDR-TB, Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal e Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rada Dukpa
- . National TB Control Program, Ministry of Health, Timbu, Bhutan
| | - José-María García-García
- . Programa Integrado de Investigación en Tuberculosis - PII-TB - Sociedad Española de Neumología y Cirugía Torácica - SEPAR - Barcelona, España
| | - Gina Gualano
- . Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani” - INMI - IRCCS, Roma, Italia
| | - Xhevat Kurhasani
- . UBT - Higher Education Institution, Prishtina, Kosovo
- . NGO KeA, Prishtina, Kosovo
| | - Katerina Manika
- . Pulmonary Department, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Thessaloniki, Greece
| | | | - Kristin Pahl
- . Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Adrian Rendon
- . Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias -CIPTIR - Hospital Universitario de Monterrey, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Giovanni Sotgiu
- . Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Tania A. Thomas
- . Division of Infectious Diseases and International Health, University of Virginia, Charlottesville (VA) USA
| | - Simon Tiberi
- . Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- . Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Heinke Kunst
- . Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- . Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Zarir F. Udwadia
- . P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Delia Goletti
- . Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani” - INMI - IRCCS, Roma, Italia
| | - Rosella Centis
- . Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | | | - Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS- Porto Alegre, Brasil
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Gupta RK, Lule SA, Krutikov M, Gosce L, Green N, Southern J, Imran A, Aldridge RW, Kunst H, Lipman M, Lynn W, Burgess H, Rahman A, Menezes D, Rahman A, Tiberi S, White PJ, Abubakar I. Screening for tuberculosis among high-risk groups attending London emergency departments: a prospective observational study. Eur Respir J 2021; 57:2003831. [PMID: 33737408 PMCID: PMC8223173 DOI: 10.1183/13993003.03831-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/23/2021] [Indexed: 11/05/2022]
Abstract
Most tuberculosis (TB) cases in low-incidence settings are thought to be due to reactivation of latent TB infection (LTBI) in high-risk populations [1–3]. Assessment of patients at emergency departments (EDs) is a potential opportunity to achieve early TB diagnosis, and interrupt transmission. An earlier study in London found that 39% of patients diagnosed with TB had attended an ED in the preceding 6 months [4]. Of these, 76% had a chest radiograph performed, of which 86% and 40% were abnormal in cases of pulmonary and extrapulmonary TB, respectively. Attendance at EDs provides an opportunity to identify individuals with LTBI, who may be at risk for progression to active disease and unlikely to engage with healthcare services via other routes. LTBI screening among high-risk groups at EDs could be implemented to identify those at risk of progression to TB disease. Large-scale studies are required to investigate effective TB disease screening strategies in EDs. https://bit.ly/3bTkoOn
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Affiliation(s)
- Rishi K Gupta
- Institute for Global Health, University College London, London, UK
| | - Swaib A Lule
- Institute for Global Health, University College London, London, UK
| | - Maria Krutikov
- Institute for Global Health, University College London, London, UK
| | - Lara Gosce
- Institute for Global Health, University College London, London, UK
| | - Nathan Green
- MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London, UK
| | - Jo Southern
- TB Unit, Public Health England, Colindale, London, UK
| | | | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, UK
- UCL-TB and UCL Respiratory, University College London, London, UK
| | - William Lynn
- London North West University NHS Trust, London, UK
| | - Helen Burgess
- West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Asif Rahman
- Imperial College London NHS Trust, London, UK
| | - Dee Menezes
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Ananna Rahman
- Blizard Institute, Queen Mary University of London, London, UK
| | - Simon Tiberi
- Blizard Institute, Queen Mary University of London, London, UK
- Division of Infection, Barts Health NHS Trust, London, UK
| | - Peter J White
- MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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Chandra A, Kumar R, Kant S, Krishnan A. Diagnostic Pathways and Delays in Initiation of Treatment among Newly Diagnosed Tuberculosis Patients in Ballabgarh, India. Am J Trop Med Hyg 2021; 104:1321-1325. [PMID: 33617478 DOI: 10.4269/ajtmh.20-1297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/05/2021] [Indexed: 11/07/2022] Open
Abstract
A delay in diagnosis and initiation of treatment in patients with tuberculosis (TB) can affect the period of communicability and cost of treatment. We aimed to describe the diagnostic pathways and delays in initiation of treatment among drug-sensitive newly diagnosed TB patients in Ballabgarh, India. In May 2019, we interviewed 110 TB patients who were put on treatment in the past 2 months. It was a cross-sectional study where data collection was conducted by a physician. We used a structured questionnaire to collect the information on care-seeking practices, delays, and patient's cost. Descriptive analysis was carried out for the pathways, delays, and patient cost. The mean number of health facility contacted before the diagnosis of TB was 2.8 (SD: 1.3); 76% of patients first sought care at a private health facility. The median total delay was 34.5 (IQR: 21-60) days; median patient delay seven (IQR: 2-21) days, median health system delay 16 (IQR: 8-45) days, median diagnostic delay 32.5 (IQR: 18-57) days, and median treatment delay two (IQR: 1-3) days. Health system delay was 2.2 times longer than patient delay; the health system delay was primarily due to delay in diagnosis. Patients contacting private health facility first had 1.7 times total delay, 2.4 times longer health system delay, and 3.4 times of direct cost compared with patients contacting a public health facility first. Accelerated efforts are needed to achieve India's target to eliminate TB by 2025.
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Furin J. Advances in the diagnosis, treatment, and prevention of tuberculosis in children. Expert Rev Respir Med 2019; 13:301-311. [PMID: 30648437 DOI: 10.1080/17476348.2019.1569518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pediatric tuberculosis (TB) is a significant global health threat and is one of the top ten causes of death in children. There are a number of diagnostic, treatment, and preventive innovations that have been developed in the last decade for TB, however, these are out of reach for many children in the world. Areas covered: A comprehensive review of the literature on TB in children was done using PubMed and Ovid databases from 1 January 1996 up to 31 October 2018. Topic areas covered included diagnosis of TB, treatment of TB (including novel medications and regimens), prevention of DR-TB, and support to achieve the best possible outcomes. Each of these areas are explored in more detail in the paper. Expert commentary: There is great potential for radical changes in the way all forms of TB are diagnosed, treated and prevented in children. If there is continued advocacy and adequate funding and accountability, it could be possible to make great strides toward eliminating TB in children in the next ten years.
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Affiliation(s)
- Jennifer Furin
- a Harvard Medical School , Department of Global Health and Social Medicine , Boston , MA , USA
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The Tuberculosis Cascade of Care in India's Public Sector: A Systematic Review and Meta-analysis. PLoS Med 2016; 13:e1002149. [PMID: 27780217 PMCID: PMC5079571 DOI: 10.1371/journal.pmed.1002149] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/09/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND India has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world's "missing" patients, which includes those who may not have received effective TB care and could potentially spread TB to others. The "cascade of care" is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions. METHODS AND FINDINGS The care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India's TB patients. We define the TB cascade as including the following patient populations: total prevalent active TB patients in India, TB patients who reach and undergo evaluation at RNTCP diagnostic facilities, patients successfully diagnosed with TB, patients who start treatment, patients retained to treatment completion, and patients who achieve 1-y recurrence-free survival. We estimate each step of the cascade for 2013 using data from two World Health Organization (WHO) reports (2014-2015), one WHO dataset (2015), and three RNTCP reports (2014-2016). In addition, we conduct three targeted systematic reviews of the scientific literature to identify 39 unique articles published from 2000-2015 that provide additional data on five indicators that help estimate different steps of the TB cascade. We construct separate care cascades for the overall population of patients with active TB and for patients with specific forms of TB-including new smear-positive, new smear-negative, retreatment smear-positive, and multidrug-resistant (MDR) TB. The WHO estimated that there were 2,700,000 (95%CI: 1,800,000-3,800,000) prevalent TB patients in India in 2013. Of these patients, we estimate that 1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%) were successfully diagnosed; 1,417,838 (53%) got registered for treatment; 1,221,764 (45%) completed treatment; and 1,049,237 (95%CI: 1,008,775-1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal outcome of 1-y recurrence-free survival. The separate cascades for different forms of TB highlight different patterns of patient attrition. Pretreatment loss to follow-up of diagnosed patients and post-treatment TB recurrence were major points of attrition in the new smear-positive TB cascade. In the new smear-negative and MDR TB cascades, a substantial proportion of patients who were evaluated at RNTCP diagnostic facilities were not successfully diagnosed. Retreatment smear-positive and MDR TB patients had poorer treatment outcomes than the general TB population. Limitations of our analysis include the lack of available data on the cascade of care in the private sector and substantial uncertainty regarding the 1-y period prevalence of TB in India. CONCLUSIONS Increasing case detection is critical to improving outcomes in India's TB cascade of care, especially for smear-negative and MDR TB patients. For new smear-positive patients, pretreatment loss to follow-up and post-treatment TB recurrence are considerable points of attrition that may contribute to ongoing TB transmission. Future multisite studies providing more accurate information on key steps in the public sector TB cascade and extension of this analysis to private sector patients may help to better target interventions and resources for TB control in India.
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Murray M, Cattamanchi A, Denkinger C, Van't Hoog A, Pai M, Dowdy D. Cost-effectiveness of triage testing for facility-based systematic screening of tuberculosis among Ugandan adults. BMJ Glob Health 2016; 1:e000064. [PMID: 28588939 PMCID: PMC5321327 DOI: 10.1136/bmjgh-2016-000064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/12/2016] [Accepted: 07/26/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Systematic screening is often proposed as a way to improve case finding for tuberculosis (TB), but the cost-effectiveness of specific strategies for systematic screening remains poorly studied. METHODS We constructed a Markov-based decision analytic model to analyse the cost-effectiveness of triage testing for TB in Uganda, compared against passive case detection with Xpert MTB/RIF. We assumed a triage algorithm whereby all adults presenting to healthcare centres would be screened for cough, and those with cough of at least 2 weeks would receive the triage test, with positive triage results confirmed by Xpert MTB/RIF. We adopted the perspective of the TB control sector, using a primary outcome of the cost per year of life gained (YLG) over a lifetime time horizon. RESULTS Systematic screening in a population with a 5% underlying prevalence of TB was estimated to cost US$610 per YLG (95% uncertainty range US$200-US$1859) with chest X-ray (CXR) (US$5 per test, specificity 0.67), or US$588 (US$221-US$1746) with C reactive protein (CRP) (US$3 per test, specificity 0.59). In addition to the cost and specificity of the triage test, cost-effectiveness was most sensitive to the underlying prevalence of TB, monthly risk of mortality in people with untreated TB and the proportion of patients with TB who would be treated in the absence of systematic screening. CONCLUSIONS To optimise the cost-effectiveness of facility-based systematic screening of TB with a triage test, it must be carried out in a high-risk population, or use triage tests that are cheaper or more specific than CXR or CRP.
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Affiliation(s)
- Matthew Murray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Claudia Denkinger
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Anja Van't Hoog
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | - Madhukar Pai
- Department of Epidemiology & Biostatistics, McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ticona E, Huaman MA, Huaroto LM, Burgos M, Brett M, Escombe R, Moore DAJ. Tuberculosis screening using ability to provide sputum in an endemic emergency department. Eur Respir J 2016; 47:330-3. [PMID: 26493789 PMCID: PMC4703042 DOI: 10.1183/13993003.00877-2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/10/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Eduardo Ticona
- Infectious Diseases and Tropical Medicine Service, Dept of Medical Specialties, Hospital Nacional Dos de Mayo, Lima, Peru Dept of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Moises A Huaman
- Division of Infectious Diseases, Dept of Medicine, University of Kentucky, Lexington, KY, USA
| | - Luz Maria Huaroto
- Infectious Diseases and Tropical Medicine Service, Dept of Medical Specialties, Hospital Nacional Dos de Mayo, Lima, Peru Dept of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Marcos Burgos
- Division of Infectious Diseases, Dept of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Meghan Brett
- Division of Infectious Diseases, Dept of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Rod Escombe
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - David A J Moore
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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