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Mugwagwa T, Abubakar I, White PJ. Using molecular testing and whole-genome sequencing for tuberculosis diagnosis in a low-burden setting: a cost-effectiveness analysis using transmission-dynamic modelling. Thorax 2021; 76:281-291. [PMID: 33542086 DOI: 10.1136/thoraxjnl-2019-214004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite progress in TB control in low-burden countries like England and Wales, there are still diagnostic delays. Molecular testing and/or whole-genome sequencing (WGS) provide more rapid diagnosis but their cost-effectiveness is relatively unexplored in low-burden settings. METHODS An integrated transmission-dynamic health economic model is used to assess the cost-effectiveness of using WGS to replace culture-based drug-sensitivity testing, versus using molecular testing versus combined use of WGS and molecular testing, for routine TB diagnosis. The model accounts for the effects of faster appropriate treatment in reducing transmission, benefiting health and reducing future treatment costs. Cost-effectiveness is assessed using incremental net benefit (INB) over a 10-year horizon with a quality-adjusted life-year valued at £20 000, and discounting at 3.5% per year. RESULTS WGS shortens the time to drug sensitivity testing and treatment modification where necessary, reducing treatment and hospitalisation costs, with an INB of £7.1 million. Molecular testing shortens the time to TB diagnosis and treatment. Initially, this causes an increase in annual costs of treatment, but averting transmissions and future active TB disease subsequently, resulting in cost savings and health benefits to achieve an INB of £8.6 million (GeneXpert MTB/RIF) or £11.1 million (Xpert-Ultra). Combined use of Xpert-Ultra and WGS is the optimal strategy we consider, with an INB of £16.5 million. CONCLUSION Routine use of WGS or molecular testing is cost-effective in a low-burden setting, and combined use is the most cost-effective option. Adoption of these technologies can help low-burden countries meet the WHO End TB Strategy milestones, particularly the UK, which still has relatively high TB rates.
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Affiliation(s)
- Tendai Mugwagwa
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK.,MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Peter J White
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK .,MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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2
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Xu Y, Stockdale JE, Naidu V, Hatherell H, Stimson J, Stagg HR, Abubakar I, Colijn C. Transmission analysis of a large tuberculosis outbreak in London: a mathematical modelling study using genomic data. Microb Genom 2020; 6:mgen000450. [PMID: 33174832 PMCID: PMC7725332 DOI: 10.1099/mgen.0.000450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Outbreaks of tuberculosis (TB) - such as the large isoniazid-resistant outbreak centred on London, UK, which originated in 1995 - provide excellent opportunities to model transmission of this devastating disease. Transmission chains for TB are notoriously difficult to ascertain, but mathematical modelling approaches, combined with whole-genome sequencing data, have strong potential to contribute to transmission analyses. Using such data, we aimed to reconstruct transmission histories for the outbreak using a Bayesian approach, and to use machine-learning techniques with patient-level data to identify the key covariates associated with transmission. By using our transmission reconstruction method that accounts for phylogenetic uncertainty, we are able to identify 21 transmission events with reasonable confidence, 9 of which have zero SNP distance, and a maximum distance of 3. Patient age, alcohol abuse and history of homelessness were found to be the most important predictors of being credible TB transmitters.
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Affiliation(s)
- Yuanwei Xu
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | | | - Vijay Naidu
- Department of Mathematics, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | | | - James Stimson
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
- National Infection Service, Public Health England, London, UK
| | - Helen R. Stagg
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Caroline Colijn
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
- Department of Mathematics, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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3
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Story A, Garber E, Aldridge RW, Smith CM, Hall J, Ferenando G, Possas L, Hemming S, Wurie F, Luchenski S, Abubakar I, McHugh TD, White PJ, Watson JM, Lipman M, Garfein R, Hayward AC. Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background
Socially complex groups, including people experiencing homelessness, prisoners and drug users, have very high levels of tuberculosis, often complicated by late diagnosis and difficulty in adhering to treatment.
Objective
To assess a series of interventions to improve tuberculosis control in socially complex groups.
Design
A series of observational surveys, evaluations and trials of interventions.
Setting
The pan-London Find&Treat service, which supports tuberculosis screening and case management in socially complex groups across London.
Participants
Socially complex groups with tuberculosis or at risk of tuberculosis, including people experiencing homelessness, prisoners, drug users and those at high risk of poor adherence to tuberculosis treatment.
Interventions and main outcome measures
We screened 491 people in homeless hostels and 511 people in prison for latent tuberculosis infection, human immunodeficiency virus, hepatitis B and hepatitis C. We evaluated an NHS-led prison radiographic screening programme. We conducted a cluster randomised controlled trial (2348 eligible people experiencing homelessness in 46 hostels) of the effectiveness of peer educators (22 hostels) compared with NHS staff (24 hostels) at encouraging the uptake of mobile radiographic screening. We initiated a trial of the use of point-of-care polymerase chain reaction diagnostics to rapidly confirm tuberculosis alongside mobile radiographic screening. We undertook a randomised controlled trial to improve treatment adherence, comparing face-to-face, directly observed treatment with video-observed treatment using a smartphone application. The primary outcome was completion of ≥ 80% of scheduled treatment observations over the first 2 months following enrolment. We assessed the cost-effectiveness of latent tuberculosis screening alongside radiographic screening of people experiencing homelessness. The costs of video-observed treatment and directly observed treatment were compared.
Results
In the homeless hostels, 16.5% of people experiencing homelessness had latent tuberculosis infection, 1.4% had current hepatitis B infection, 10.4% had hepatitis C infection and 1.0% had human immunodeficiency virus infection. When a quality-adjusted life-year is valued at £30,000, the latent tuberculosis screening of people experiencing homelessness was cost-effective provided treatment uptake was ≥ 25% (for a £20,000 quality-adjusted life-year threshold, treatment uptake would need to be > 50%). In prison, 12.6% of prisoners had latent tuberculosis infection, 1.9% had current hepatitis B infection, 4.2% had hepatitis C infection and 0.0% had human immunodeficiency virus infection. In both settings, levels of latent tuberculosis infection and blood-borne viruses were higher among injecting drug users. A total of 1484 prisoners were screened using chest radiography over a total of 112 screening days (new prisoner screening coverage was 43%). Twenty-nine radiographs were reported as potentially indicating tuberculosis. One prisoner began, and completed, antituberculosis treatment in prison. In the cluster randomised controlled trial of peer educators to increase screening uptake, the median uptake was 45% in the control arm and 40% in the intervention arm (adjusted risk ratio 0.98, 95% confidence interval 0.80 to 1.20). A rapid diagnostic service was established on the mobile radiographic unit but the trial of rapid diagnostics was abandoned because of recruitment and follow-up difficulties. We randomly assigned 112 patients to video-observed treatment and 114 patients to directly observed treatment. Fifty-eight per cent of those recruited had a history of homelessness, addiction, imprisonment or severe mental health problems. Seventy-eight (70%) of 112 patients on video-observed treatment achieved the primary outcome, compared with 35 (31%) of 114 patients on directly observed treatment (adjusted odds ratio 5.48, 95% confidence interval 3.10 to 9.68; p < 0.0001). Video-observed treatment was superior to directly observed treatment in all demographic and social risk factor subgroups. The cost for 6 months of treatment observation was £1645 for daily video-observed treatment, £3420 for directly observed treatment three times per week and £5700 for directly observed treatment five times per week.
Limitations
Recruitment was lower than anticipated for most of the studies. The peer advocate study may have been contaminated by the fact that the service was already using peer educators to support its work.
Conclusions
There are very high levels of latent tuberculosis infection among prisoners, people experiencing homelessness and drug users. Screening for latent infection in people experiencing homelessness alongside mobile radiographic screening would be cost-effective, providing the uptake of treatment was 25–50%. Despite ring-fenced funding, the NHS was unable to establish static radiographic screening programmes. Although we found no evidence that peer educators were more effective than health-care workers in encouraging the uptake of mobile radiographic screening, there may be wider benefits of including peer educators as part of the Find&Treat team. Utilising polymerase chain reaction-based rapid diagnostic testing on a mobile radiographic unit is feasible. Smartphone-enabled video-observed treatment is more effective and cheaper than directly observed treatment for ensuring that treatment is observed.
Future work
Trials of video-observed treatment in high-incidence settings are needed.
Trial registration
Current Controlled Trials ISRCTN17270334 and ISRCTN26184967.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alistair Story
- Institute of Health Informatics, University College London, London, UK
- Find&Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - Elizabeth Garber
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
| | - Catherine M Smith
- Institute of Health Informatics, University College London, London, UK
| | - Joe Hall
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Gloria Ferenando
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Lucia Possas
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Sara Hemming
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Fatima Wurie
- Institute of Health Informatics, University College London, London, UK
| | - Serena Luchenski
- Institute of Health Informatics, University College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Timothy D McHugh
- Centre for Clinical Microbiology, University College London, London, UK
| | - Peter J White
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - John M Watson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, UK
- Respiratory Medicine, Division of Medicine, University College London, London, UK
| | - Richard Garfein
- Division of Global Public Health, School of Medicine, University of California, San Diego, CA, USA
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
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Liu S, Zhang R, Lu X. The Impact of Individuals' Attitudes Toward Health Websites on Their Perceived Quality of Health Information: An Empirical Study. Telemed J E Health 2018; 25:1099-1107. [PMID: 30585763 DOI: 10.1089/tmj.2018.0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A growing number of patients have increasingly used health websites to search and gather health information. Nevertheless, few studies have focused on the driving factors of internet health information quality from the perspective of psychology. Accordingly, this study explores how the attitudes of individuals toward health websites affect their perceived quality of internet health information through the mediation of seeking behavior on treatment information by employing regulatory focus theory. Materials and Methods: We defined six hypotheses that both trust in health websites and expectancy of health websites have a positive impact on emerging and conservative treatment-related online health information seeking; emerging treatment seeking has a negative impact on internet health information quality; and conservative treatment seeking has a positive impact on internet health information quality. Emerging treatment refers to some therapies based on new technologies or research, which is barely used, whereas conservative treatment is more common among the medical field. An online survey involving 336 valid participants was conducted in China. In the research model, all variables were measured using multiple-item scales, and structural equation modeling was employed for testing the hypotheses. Results: The expectancy of health websites significantly affects conservative and emerging treatment-related online health information seeking, but trust in health websites does not. Moreover, trust in health websites strongly affects the expectancy of health websites, and attitudes toward health websites have a strong effect on conservative treatment-related online information seeking. The effect of conservative treatment-related online health information seeking was considerably larger than that of emerging treatment-related online health information seeking on perceived quality of internet health information. Conclusions: From the perspective of health websites operators and public hospitals, conservative treatment and online service might be worth providing and improving. Cooperation between health websites and hospitals might be a good choice.
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Affiliation(s)
- Siying Liu
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Runtong Zhang
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Xinyi Lu
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, China
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5
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Aadnanes O, Wallis S, Harstad I. A cross-sectional survey of the knowledge, attitudes and practices regarding tuberculosis among general practitioners working in municipalities with and without asylum centres in eastern Norway. BMC Health Serv Res 2018; 18:987. [PMID: 30572893 PMCID: PMC6302494 DOI: 10.1186/s12913-018-3792-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of tuberculosis (TB) cases in Norway is increasing due to immigration from countries with high TB prevalence and few studies have been conducted on general practitioners' (GPs) knowledge of TB in low incidence countries. The main purpose of this study was to explore knowledge, attitudes and practices of TB among Norwegian GPs using a modified Knowledge Attitude Practice (KAP) survey template. METHODS A cross-sectional survey of 30 questions was distributed by email using SurveyMonkey to GPs working in municipalities either with or without an asylum reception centre in Eastern Norway (GPwAS or GPw/oAS). The questionnaire assessed demographic data and had 14 questions on TB knowledge and 7 questions on attitudes and practices. Descriptive and inferential analysis of the data was carried out using SPSS 18. RESULTS One hundred ninety five GPs responded and 42% worked in a municipality with an asylum reception centre. There was no significant difference between the two GP groups in relation to demographic variables (all p-values > 0.2). GPwAS were more experienced in diagnosing TB patients compared to GPw/oAS (63.4% vs 44.2%, p = 0.008). There was no significant differences in participation in TB training between the two groups (8.5% vs 7.6%, p = 0.71). The majority of GPs (69%) did not consider TB as a major public health threat and misconceptions of TB epidemiology were identified. Overall, 97 (49.7%) GPs had good TB knowledge level and good TB knowledge level was associated with experience in diagnosing TB patients (p = 0.001) and recent TB training (p = 0.015). CONCLUSION Gaps in TB knowledge and awareness among GPs in Norway need to be addressed if GPs are to be more involved in TB management and prevention in the future. TB training had an effect on the GPs knowledge level and GPwAS had more experience with TB patients but our survey revealed no major differences in KAP between GPwAS and GPw/oAS.
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Affiliation(s)
- Oddvar Aadnanes
- Present Address: Legehuset Nova, Torggata 1, N-2317, Hamar, Norway. .,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7489, Trondheim, NO, Norway.
| | - Selina Wallis
- Public Health Institute, John Moores University, Liverpool, UK
| | - Ingunn Harstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7489, Trondheim, NO, Norway.,Department of Pulmonary Medicine, St Olavs University Hospital, Po Box3250 Sluppen, N-7006, Trondheim, Norway
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6
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Gubay F, Staunton R, Metzig C, Abubakar I, White PJ. Assessing uncertainty in the burden of hepatitis C virus: Comparison of estimated disease burden and treatment costs in the UK. J Viral Hepat 2018; 25:514-523. [PMID: 29274178 PMCID: PMC5947569 DOI: 10.1111/jvh.12847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/23/2017] [Indexed: 12/15/2022]
Abstract
Hepatitis C virus (HCV) is a major and growing public health concern. We need to know the expected health burden and treatment cost, and understand uncertainty in those estimates, to inform policymaking and future research. Two models that have been important in informing treatment guidelines and assessments of HCV burden were compared by simulating cohorts of individuals with chronic HCV infection initially aged 20, 35 and 50 years. One model predicts that health losses (measured in quality-adjusted life-years [QALYs]) and treatment costs decrease with increasing initial age of the patients, whilst the other model predicts that below 40 years, costs increase and QALY losses change little with age, and above 40 years, they decline with increasing age. Average per-patient costs differ between the models by up to 38%, depending on the patients' initial age. One model predicts double the total number, and triple the peak annual incidence, of liver transplants compared to the other model. One model predicts 55%-314% more deaths than the other, depending on the patients' initial age. The main sources of difference between the models are estimated progression rates between disease states and rates of health service utilization associated with different disease states and, in particular, the age dependency of these parameters. We conclude that decision-makers need to be aware that uncertainties in the health burden and economic cost of HCV disease have important consequences for predictions of future need for care and cost-effectiveness of interventions to avert HCV transmission, and further quantification is required to inform decisions.
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Affiliation(s)
- F. Gubay
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling MethodologySchool of Public HealthImperial College LondonLondonUK
| | - R. Staunton
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling MethodologySchool of Public HealthImperial College LondonLondonUK
| | - C. Metzig
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling MethodologySchool of Public HealthImperial College LondonLondonUK
- Department of MathematicsImperial College LondonLondonUK
| | - I. Abubakar
- Institute for Global HealthUniversity College LondonLondonUK
- Medical DirectoratePublic Health EnglandLondonUK
- MRC Clinical Trials UnitUniversity College LondonLondonUK
| | - P. J. White
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling MethodologySchool of Public HealthImperial College LondonLondonUK
- Modelling and Economics UnitNational Infection ServicePublic Health EnglandLondonUK
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7
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Riccardi N, Giannini B, Borghesi ML, Taramasso L, Cattaneo E, Cenderello G, Toscanini F, Giacomini M, Pontali E, Cassola G, Viscoli C, Di Biagio A. Time to change the single-centre approach to management of patients with tuberculosis: a novel network platform with automatic data import and data sharing. ERJ Open Res 2018; 4:00108-2017. [PMID: 29410957 PMCID: PMC5795190 DOI: 10.1183/23120541.00108-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/07/2017] [Indexed: 12/22/2022] Open
Abstract
Time to change the single-centre approach to TB http://ow.ly/lCeM30hBcbB.
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Affiliation(s)
- Niccolò Riccardi
- University of Genoa, Genoa, Italy.,Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
| | - Barbara Giannini
- Dept of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Maria Lucia Borghesi
- University of Genoa, Genoa, Italy.,Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Taramasso
- University of Genoa, Genoa, Italy.,Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
| | - Elena Cattaneo
- University of Genoa, Genoa, Italy.,Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Federica Toscanini
- Clinic of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Dept of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy.,Infectious Diseases, Ospedali Galliera, Genoa, Italy.,Clinic of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy.,Healthropy, Savona, Italy
| | | | | | - Claudio Viscoli
- University of Genoa, Genoa, Italy.,Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Di Biagio
- Clinic of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
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8
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Mugwagwa T, Stagg HR, Abubakar I, White PJ. Comparing different technologies for active TB case-finding among the homeless: a transmission-dynamic modelling study. Sci Rep 2018; 8:1433. [PMID: 29362378 PMCID: PMC5780390 DOI: 10.1038/s41598-018-19757-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/13/2017] [Indexed: 01/06/2023] Open
Abstract
Homeless persons have elevated risk of tuberculosis (TB) and are under-served by conventional health services. Approaches to active case-finding (ACF) and treatment tailored to their needs are required. A transmission-dynamic model was developed to assess the effectiveness and efficiency of screening with mobile Chest X-ray, GeneXpert, or both. Effectiveness of ACF depends upon the prevalence of infection in the population (which determines screening 'yield'), patient willingness to wait for GeneXpert results, and treatment adherence. ACF is efficient when TB prevalence exceeds 78/100,000 and 46% of drug sensitive TB cases and 33% of multi-drug resistant TB cases complete treatment. This threshold increases to 92/100,000 if additional post-ACF enhanced case management (ECM) increases treatment completion to 85%. Generally, the most efficient option is one-step screening of all patients with GeneXpert, but if too many patients (>27% without ECM, >19% with ECM) are unwilling to wait the 90 minutes required then two-step screening using chest X-ray (which is rapid) followed by GeneXpert for confirmation of TB is the most efficient option. Targeted ACF and support services benefit health through early successful treatment and averting TB transmission and disease. The optimal strategy is setting-specific, requiring careful consideration of patients' needs regarding testing and treatment.
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Affiliation(s)
- Tendai Mugwagwa
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK.
- MRC Centre for Outbreak Analysis and Modelling, and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Helen R Stagg
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
- Medical Directorate, Public Health England, London, UK
| | - Peter J White
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- MRC Centre for Outbreak Analysis and Modelling, and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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9
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White PJ, Abubakar I, Aldridge RW, Hayward AC. Post-migration follow-up of migrants at risk of tuberculosis. THE LANCET. INFECTIOUS DISEASES 2017; 17:1124. [PMID: 29115264 DOI: 10.1016/s1473-3099(17)30567-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Peter J White
- MRC Centre for Outbreak Analysis and Modelling, NIHR Health Protection Research Unit in Modelling Methodology, and Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK; Modelling and Economics Unit, National Infection Service, Public Health England, London, UK.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK; Medical Directorate, Public Health England, London, UK
| | - Robert W Aldridge
- Institute for Global Health, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
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