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Leukes VN, Hella J, Sabi I, Cossa M, Khosa C, Erkosar B, Mangu C, Siyame E, Mtafya B, Lwilla A, Viegas S, Madeira C, Machiana A, Ribeiro J, Garcia-Basteiro AL, Riess F, Elísio D, Sasamalo M, Mhalu G, Denkinger CM, Castro MDM, Bashir S, Schumacher SG, Tagliani E, Malhotra A, Dowdy D, Schacht C, Buech J, Nguenha D, Ntinginya N, Ruhwald M, Penn-Nicholson A, Kranzer K. Study protocol: a pragmatic, cluster-randomized controlled trial to evaluate the effect of implementation of the Truenat platform/MTB assays at primary health care clinics in Mozambique and Tanzania (TB-CAPT CORE). BMC Infect Dis 2024; 24:107. [PMID: 38243223 PMCID: PMC10797907 DOI: 10.1186/s12879-023-08876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In 2020, the WHO-approved Molbio Truenat platform and MTB assays to detect Mycobacterium tuberculosis complex (MTB) and resistance to rifampicin directly on sputum specimens. This primary health care center-based trial in Mozambique and Tanzania investigates the effect of Truenat platform/MTB assays (intervention arm) combined with rapid communication of results compared to standard of care on TB diagnosis and treatment initiation for microbiologically confirmed TB at 7 days from enrolment. METHODS The Tuberculosis Close the Gap, Increase Access, and Provide Adequate Therapy (TB-CAPT) CORE trial employs a pragmatic cluster randomized controlled design to evaluate the impact of a streamlined strategy for delivery of Truenat platform/MTB assays testing at primary health centers. Twenty-nine centers equipped with TB microscopy units were selected to participate in the trial. Among them, fifteen health centers were randomized to the intervention arm (which involves onsite molecular testing using Truenat platform/MTB assays, process process optimization to enable same-day TB diagnosis and treatment initiation, and feedback on Molbio platform performance) or the control arm (which follows routine care, including on-site sputum smear microscopy and the referral of sputum samples to off-site Xpert testing sites). The primary outcome of the study is the absolute number and proportion of participants with TB microbiological confirmation starting TB treatment within 7 days of their first visit. Secondary outcomes include time to bacteriological confirmation, health outcomes up to 60 days from first visit, as well as user preferences, direct cost, and productivity analyses. ETHICS AND DISSEMINATION TB-CAPT CORE trial has been approved by regulatory and ethical committees in Mozambique and Tanzania, as well as by each partner organization. Consent is informed and voluntary, and confidentiality of participants is maintained throughout. Study findings will be presented at scientific conferences and published in peer-reviewed international journals. TRIAL REGISTRATION US National Institutes of Health's ClinicalTrials.gov, NCT04568954. Registered 23 September 2020.
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Affiliation(s)
| | - J Hella
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - I Sabi
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - M Cossa
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - C Khosa
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | | | - C Mangu
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - E Siyame
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - B Mtafya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - A Lwilla
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - S Viegas
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - C Madeira
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - A Machiana
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - J Ribeiro
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - A L Garcia-Basteiro
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - F Riess
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany
| | - D Elísio
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - M Sasamalo
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - G Mhalu
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - C M Denkinger
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | - M D M Castro
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | - S Bashir
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | | | - E Tagliani
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Malhotra
- Johns Hopkins University (JHU), Baltimore, MD, USA
| | - D Dowdy
- Johns Hopkins University (JHU), Baltimore, MD, USA
| | | | - J Buech
- LINQ Management, Berlin, Germany
| | - D Nguenha
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - N Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | | | | | - K Kranzer
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany.
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
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Seguin M, Dringus S, Chiomvu S, Apollo T, Sibanda E, Simms V, Bernays S, Chikodzore R, Redzo N, Mlilo P, Ndlovu L, Nzombe P, Ncube B, Kranzer K, Abbas Ferrand R, Chikwari CD. Process evaluation of an intervention to improve HIV treatment outcomes among children and adolescents. Public Health Action 2022; 12:108-114. [PMID: 36160722 PMCID: PMC9484595 DOI: 10.5588/pha.22.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
SETTING Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV. OBJECTIVES To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents' perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months' post-HIV diagnosis. DESIGN We drew upon: 1) semi-structured interviews (n = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes). RESULTS Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (n = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers. CONCLUSION This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions.
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Affiliation(s)
- M Seguin
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S Dringus
- Global Health Department, London School of Hygiene and Tropical Medicine, London, UK
| | - S Chiomvu
- Million Memory Project Zimbabwe, Bulawayo, Zimbabwe
| | - T Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - E Sibanda
- Health Services Department, Bulawayo City Health, Bulawayo, Zimbabwe
| | - V Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe.,International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - S Bernays
- Global Health Department, London School of Hygiene and Tropical Medicine, London, UK.,School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - R Chikodzore
- Ministry of Health and Child Care, Gwanda, Zimbabwe
| | - N Redzo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - P Mlilo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - L Ndlovu
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - P Nzombe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - B Ncube
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - K Kranzer
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.,Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - R Abbas Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - C D Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Zvinoera K, Olaru ID, Khan P, Mutsvangwa J, Denkinger CM, Kampira V, Coutinho D, Mutunzi H, Pepukai M, Chikaka E, Zinyowera S, Mharakurwa S, Kranzer K. The impact of changing the diagnostic algorithm for TB in Manicaland, Zimbabwe. Public Health Action 2021; 11:196-201. [PMID: 34956848 DOI: 10.5588/pha.21.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Governmental health facilities performing TB diagnostics in Manicaland, Zimbabwe. OBJECTIVE To investigate the effect of making Xpert® MTB/RIF the primary TB diagnostic for all patients presenting with presumptive TB on 1) the number of samples investigated for TB, 2) the proportion testing TB-positive, and 3) the proportion of unsuccessful results over time. DESIGN This retrospective study used data from GeneX-pert downloads, laboratory registers and quality assurance reports between 1 January 2017 and 31 December 2018. RESULTS The total number of Xpert tests performed in Manicaland increased from 3,967 in the first quarter of 2017 to 7,011 in the last quarter of 2018. Mycobacterium tuberculosis DNA was detected in 4.9-8.6% of the samples investigated using Xpert, with a higher yield in 2017 than in 2018. The overall proportion of unsuccessful Xpert assays due to "no results", errors and invalid results was 6.3%, and highly variable across sites. CONCLUSION Roll out of more sensitive TB diagnostics does not necessarily result in an increase of microbiologically confirmed TB diagnosis. While the number of samples tested using Xpert increased, the proportion of TB-positive tests decreased. GeneXpert soft- and hardware infrastructure needs to be strengthened to reduce the rate of unsuccessful assays and therefore, costs and staff time.
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Affiliation(s)
- K Zvinoera
- Ministry of Health and Child Care, Mutare Provincial Hospital, Mutare, Zimbabwe
| | - I D Olaru
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - P Khan
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - J Mutsvangwa
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - C M Denkinger
- Division of Tropical Medicine, Centre for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.,German Centre for Infection Research (DZIF), partner site Heidelberg University Hospital, Heidelberg, Germany
| | - V Kampira
- Ministry of Health and Child Care, Mutare Provincial Hospital, Mutare, Zimbabwe
| | - D Coutinho
- Ministry of Health and Child Care, Mutare Provincial Hospital, Mutare, Zimbabwe
| | - H Mutunzi
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - M Pepukai
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - E Chikaka
- Department of Health Sciences, College of Health and Natural Sciences, Africa University, Old Mutare, Zimbabwe
| | - S Zinyowera
- National Microbiology Reference Laboratory, Ministry of Health and Child Care, Harare, Zimbabwe
| | - S Mharakurwa
- Department of Health Sciences, College of Health and Natural Sciences, Africa University, Old Mutare, Zimbabwe
| | - K Kranzer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
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Clarkson MC, McQuaid CF, Houben RM, Kranzer K, White RG. Better data for country-level TB resource allocation are urgently required. Int J Tuberc Lung Dis 2021; 25:662-664. [PMID: 34330352 DOI: 10.5588/ijtld.20.0912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M C Clarkson
- TB Modelling Group, TB Centre, Centre for Mathematical Modelling of Infectious Diseases, Department of Epidemiology and Population Health, London, UK
| | - C F McQuaid
- TB Modelling Group, TB Centre, Centre for Mathematical Modelling of Infectious Diseases, Department of Epidemiology and Population Health, London, UK
| | - R M Houben
- TB Modelling Group, TB Centre, Centre for Mathematical Modelling of Infectious Diseases, Department of Epidemiology and Population Health, London, UK
| | - K Kranzer
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, Biomedical Research and Training Institute, Harare, Zimbabwe, Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - R G White
- TB Modelling Group, TB Centre, Centre for Mathematical Modelling of Infectious Diseases, Department of Epidemiology and Population Health, London, UK
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Maurer FP, Mintken E, Rupp J, Olaru I, Kranzer K. The landscape of diagnostic mycobacteriology in Germany-challenges of decentralised care. Int J Tuberc Lung Dis 2020; 23:913-918. [PMID: 31533881 DOI: 10.5588/ijtld.18.0763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To perform a nationwide inventory of diagnostic mycobacteriology services in Germany.METHOD: A survey was conducted among participants of the national mycobacteriology external quality assurance scheme asking for smear microscopy techniques, molecular assays, culture systems and drug susceptibility testing (DST) capacities for Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM), and numbers of processed/culture-positive samples, and DSTs performed in 2016.RESULTS: We found that 170/238 laboratories (71.4%) provided data. Numbers of samples processed for culture varied between 35 and 40 000 (median 1856, interquartile range [IQR] 761-3500). Specimen numbers culture-positive for MTBC or NTM ranged from 0 to 1895 (median 46, IQR 17-116), and from 0 to 833 (median 30, IQR 13-71), respectively. Numbers of performed first-line susceptibility tests varied between 3 and 1400 (median 36, IQR 28-78). Eight laboratories performed DST for NTM. Also, 26.9% of all laboratories did not offer rapid genotypic DST (gDST) from primary samples.CONCLUSION: The landscape of diagnostic mycobacteriology in Germany is highly heterogenic with considerable variations in sample numbers and testing methodologies. Shortcomings exist with respect to fluorochrome staining of primary samples, rapid gDST of MTBC, and DST of NTM. National guidelines need to be adapted accordingly.
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Affiliation(s)
- F P Maurer
- National Reference Centre for Mycobacteria, Research Centre Borstel, Borstel
| | - E Mintken
- National Reference Centre for Mycobacteria, Research Centre Borstel, Borstel
| | - J Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, German Centre for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - I Olaru
- Biomedical Research and Training Institute, Harare, Zimbabwe, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - K Kranzer
- National Reference Centre for Mycobacteria, Research Centre Borstel, Borstel, Biomedical Research and Training Institute, Harare, Zimbabwe, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Ismail NA, Said HM, Rodrigues C, Omar SV, Ajbani K, Sukhadiad N, Kohl TA, Niemann S, Kranzer K, Diels M, Rigouts L, Rüsch-Gerdes S, Siddiqi S. Multicentre study to establish interpretive criteria for clofazimine drug susceptibility testing. Int J Tuberc Lung Dis 2020; 23:594-599. [PMID: 31097068 DOI: 10.5588/ijtld.18.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec id="st1"> <title>OBJECTIVE</title> To conduct a multicentre study to establish the critical concentration (CC) for clofazimine (CFZ) for drug susceptibility testing (DST) of Mycobacterium tuberculosis on the MGIT™960™ system using the distribution of minimum inhibitory concentrations (MIC) and genotypic analyses of Rv0678 mutations. </sec> <sec id="st2"> <title>DESIGN</title> In phase I of the study, the MIC distribution of laboratory strains (H37Rv and in vitro-selected Rv0678 mutants) and clinical pan-susceptible isolates were determined (n = 70). In phase II, a tentative CC for CFZ (n = 55) was proposed. In phase III, the proposed CC was validated using clinical drug-resistant tuberculosis (DR-TB) isolates stratified by Rv0678 mutation (n = 85). </sec> <sec id="st3"> <title>RESULTS AND CONCLUSION</title> The MIC distribution of CFZ for laboratory and clinical pan-susceptible strains ranged between 0.125 μg/ml and 0.5 μg/ml. As the MIC values of DR-TB isolates used for phase II ranged between 0.25 μg/ml and 1 μg/ml, a CC of 1 μg/ml was proposed. Validation of the CC in phase III showed that probably susceptible and probably resistant Rv0678 mutants overlapped at 1 μg/ml. We therefore recommend a CC of 1 μg/ml, with additional testing at 0.5 μg/ml to define an intermediate category. This was the first comprehensive study to establish a CC for routine phenotypic DST of CFZ using the MGIT960 system to guide therapeutic decisions. </sec>.
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Affiliation(s)
- N A Ismail
- Centre for Tuberculosis, National Institute of Communicable Diseases, South Africa Division of National Health Laboratory Services, Johannesburg, Department of Medical Microbiology, University of Pretoria, Pretoria, Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - H M Said
- Centre for Tuberculosis, National Institute of Communicable Diseases, South Africa Division of National Health Laboratory Services, Johannesburg
| | - C Rodrigues
- P D Hinduja National Hospital and Medical Centre, Mumbai
| | - S V Omar
- Centre for Tuberculosis, National Institute of Communicable Diseases, South Africa Division of National Health Laboratory Services, Johannesburg
| | - K Ajbani
- P D Hinduja National Hospital and Medical Centre, Mumbai
| | - N Sukhadiad
- Becton Dickinson India Pvt Ltd, Mumbai, India
| | - T A Kohl
- National Reference Centre for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany
| | - S Niemann
- National Reference Centre for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany
| | - K Kranzer
- National Reference Centre for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany
| | - M Diels
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp
| | - L Rigouts
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - S Rüsch-Gerdes
- National Reference Centre for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany, Department of Medical Microbiology, University of Pretoria, Pretoria
| | - S Siddiqi
- Becton Dickinson and Company, Franklin, New Jersey, USA
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Koesoemadinata RC, Kranzer K, Livia R, Susilawati N, Annisa J, Soetedjo NNM, Ruslami R, Philipsen R, van Ginneken B, Soetikno RD, van Crevel R, Alisjahbana B, Hill PC. Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus. Int J Tuberc Lung Dis 2019; 22:1088-1094. [PMID: 30092877 DOI: 10.5588/ijtld.17.0827] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a significant risk factor for tuberculosis (TB). We evaluated the performance of computer-aided detection for tuberculosis (CAD4TB) in people living with diabetes mellitus (PLWD) in Indonesia. METHODS PLWD underwent symptom screening and chest X-ray (CXR); sputum was examined in those with positive symptoms and/or CXR. Digital CXRs were scored using CAD4TB and analysed retrospectively using clinical and microbiological diagnosis as a reference. The area under the receiver operator curve (AUC) of CAD4TB scores was determined, and an optimal threshold score established. Agreement between CAD4TB and the radiologist's reading was determined. RESULTS Among 346 included PLWD, seven (2.0%) had microbiologically confirmed and two (0.6%) had clinically diagnosed TB. The highest agreement of CAD4TB with radiologist reading was achieved using a threshold score of 70 (κ = 0.41, P < 0.001). The AUC for CAD4TB was 0.89 (95%CI 0.73-1.00). A threshold score of 65 for CAD4TB resulted in a sensitivity, specificity, positive predictive value and negative predictive value of respectively 88.9% (95%CI 51.8-99.7), 88.5% (95%CI 84.6-91.7), 17.0% (95%CI 7.6-30.8) and 99.6% (95%CI 98.2-100). With this threshold, 48 (13.9%) individuals needed microbiological examination and no microbiologically confirmed cases were missed. CONCLUSIONS CAD4TB has potential as a triage tool for TB screening in PLWD, thereby significantly reducing the need for microbiological examination.
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Affiliation(s)
- R. C. Koesoemadinata
- Infectious Disease Research Centre, Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - K. Kranzer
- London School of Hygiene & Tropical Medicine, London, UK, National and Supranational Reference Laboratory, Research Centre Borstel, Germany
| | - R. Livia
- Infectious Disease Research Centre
| | | | | | - N. N. M. Soetedjo
- Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R. Ruslami
- Infectious Disease Research Centre, Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - R. Philipsen
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - B. van Ginneken
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R. D. Soetikno
- Department of Radiology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R. van Crevel
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - B. Alisjahbana
- Infectious Disease Research Centre, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P. C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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Zallet J, Olaru ID, Witt AK, Vock P, Kalsdorf B, Andres S, Hillemann D, Kranzer K. Evaluation of OMNIgene ®•SPUTUM reagent for mycobacterial culture. Int J Tuberc Lung Dis 2019; 22:945-949. [PMID: 29991406 DOI: 10.5588/ijtld.17.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING National Mycobacterium Reference Laboratory, Borstel, Germany. OBJECTIVE To evaluate the effectiveness of OMNIgene®•SPUTUM (OM-S) reagent in comparison with a method using N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) with regard to mycobacterial recovery and contamination of broth and solid cultures. DESIGN Sputum samples from patients with tuberculosis and other respiratory diseases underwent decontamination with NALC-NaOH-based (MycoDDR™) or OM-S reagent. The decontamination procedure was assigned by block randomisation. Samples were inoculated on Löwenstein-Jensen, Stonebrink and MGIT™ (Mycobacterial Growth Indicator Tubes). Mycobacterial recovery from samples spiked with Mycobacterium tuberculosis following decontamination was determined. RESULTS Eighty-five samples were randomised to NALC-NaOH and 84 to OM-S reagent. Mycobacterial recovery was significantly lower for samples processed with OM-S reagent compared with the NALC-NaOH method across all media types. Culture contamination was lower with NALC-NaOH reagent on solid media (9.4-12.9% vs. 28.6-29.8%). Growth was not observed in MGIT among samples spiked with 10 600-16 800 colony-forming units of M. tuberculosis following decontamination with OM-S reagent. CONCLUSION Low mycobacterial recovery, especially in MGIT, observed in the present study suggests that OM-S reagent might not be compatible with the MGIT system. More extensive field evaluations of the OM-S reagent are warranted to demonstrate a significant benefit over currently used methods.
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Affiliation(s)
- J Zallet
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel
| | - I D Olaru
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, London School of Hygiene & Tropical Medicine, London, UK
| | - A-K Witt
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel
| | - P Vock
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel
| | - B Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - S Andres
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel
| | - D Hillemann
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel
| | - K Kranzer
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel, London School of Hygiene & Tropical Medicine, London, UK
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9
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Olaru ID, Albert H, Zallet J, Werner UE, Ahmed N, Rieder HL, Salfinger M, Kranzer K. Impact of quality improvement in tuberculosis laboratories in low- and lower-middle-income countries: a systematic review. Int J Tuberc Lung Dis 2019; 22:309-320. [PMID: 29471910 DOI: 10.5588/ijtld.17.0629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of quality improvement measures on the performance of diagnostic tuberculosis (TB) laboratories in low- and lower-middle-income countries is not known, and is the subject of this review. METHODS Three databases were searched for quality improvement studies presenting data on performance parameters before and after the implementation of quality improvement interventions. RESULTS Twenty-one studies were included in this review. Quality improvement measures were most frequently implemented by an external organization; settings targeted ranged from microscopy centers, hospitals, districts, regional and national reference laboratories. Quality improvement interventions and outcome measurements were highly heterogeneous. Most studies investigated interventions aimed at improving smear microscopy (n = 17). Two studies evaluated comprehensive quality improvement measures (n = 2) and another three studies focused on mycobacterial culture and drug susceptibility testing. Most studies showed an improvement in outcomes measured on before-after or time trend analysis. CONCLUSION Quality improvement measures implemented in TB laboratories showed a positive impact on various outcomes. Due to the high heterogeneity of outcome reporting and interventions and the low quality of the studies, the effect size was not clear. Identification of standardized quality indicators and their link to the quality of patient care would improve knowledge in this field.
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Affiliation(s)
- I D Olaru
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - H Albert
- Foundation for Innovative New Diagnostics, Cape Town, South Africa
| | - J Zallet
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel, Germany
| | - U-E Werner
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel, Germany
| | - N Ahmed
- Centre for Clinical Microbiology, University College London, London, UK
| | - H L Rieder
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Tuberculosis Consultant Services, Kirchlindach, Switzerland
| | - M Salfinger
- Mycobacteriology and Pharmacokinetics Laboratory and Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - K Kranzer
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel, Germany, London School of Hygiene & Tropical Medicine, London, UK
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10
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Bakuła Z, Arias F, Bachiyska E, Borroni E, Cirillo DM, Coulter C, Giske C, Humięcka J, Van Ingen J, Ioannidis P, Kranzer K, Kuzmič U, Levina K, Lillebæk T, Mokrousov I, Morimoto K, Nikolayevskyy V, Norman A, Papaventsis D, Peuchant O, Safianowska A, Ulmann V, Vasiliauskiene E, Won-Jung K, Zhuravlev V, Žolnir-Dovč M, Krenke R, Jagielski T. MOLECULAR TYPING OF MYCOBACTERIUM KANSASII — A GLOBAL PERSPECTIVE. ACTA ACUST UNITED AC 2019. [DOI: 10.15789/2220-7619-2018-4-6.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Z. Bakuła
- Department of Applied Microbiology, Institute of Microbiology, Faculty of Biology, University of Warsaw, Warsaw
| | - F. Arias
- Mycobacteria Laboratory, Public Health Institute of Chile, Santiago
| | - E. Bachiyska
- National Reference Laboratory for Tuberculosis, Sofia
| | - E. Borroni
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milano
| | - D. M. Cirillo
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milano
| | - C. Coulter
- Queensland Mycobacterial Reference Laboratory, Queensland, Brisbane
| | - C. Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Solna
| | - J. Humięcka
- Hospital of Infectious Diseases in Warsaw, Warsaw
| | - J. Van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen
| | - P. Ioannidis
- National Reference Laboratory for Mycobacteria, “Sotiria” Chest Diseases Hospital of Athens
| | - K. Kranzer
- National Reference Center for Mycobacteria, Forschungszentrum Borstel, Leibniz-Zentrum für Medizin und Biowissenschaften, Borstel
| | - U. Kuzmič
- Laboratory for Mycobacteria, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik
| | - K. Levina
- Mycobacteriology Section Laboratory, North Estonia Medical Centre, Tallinn
| | - T. Lillebæk
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen
| | - I. Mokrousov
- Laboratory of Molecular Microbiology, St. Petersburg Pasteur Institute, St. Petersburg
| | - K. Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo
| | | | - A. Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen
| | - D. Papaventsis
- National Reference Laboratory for Mycobacteria, “Sotiria” Chest Diseases Hospital of Athens
| | - O. Peuchant
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux
| | - A. Safianowska
- Department of Internal Medicine, Pulmonary Diseases & Allergy, Warsaw Medical University, Warsaw
| | | | - E. Vasiliauskiene
- Infectious Diseases and Tuberculosis Hospital, Vilnius University Hospital Santariskiu Klinikos
| | - K. Won-Jung
- Division of Pulmonary and Critical Care Medicine; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - V. Zhuravlev
- Research Institute of Phthisiopulmonology, St. Petersburg
| | - M. Žolnir-Dovč
- Laboratory for Mycobacteria, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik
| | - R. Krenke
- Department of Internal Medicine, Pulmonary Diseases & Allergy, Warsaw Medical University, Warsaw
| | - T. Jagielski
- Department of Applied Microbiology, Institute of Microbiology, Faculty of Biology, University of Warsaw, Warsaw
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11
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Nikolayevskyy V, Maurer F, Holicka Y, Taylor L, Liddy H, Hillemann D, Network ERLTBN, Kranzer K. DEVELOPMENT OF THE EXTERNAL QUALITY ASSESSMENT SCHEME FOR NON-TUBERCULOUS MYCOBACTERIA DRUG SUSCEPTIBILITY TESTING IN EUROPEAN UNION. ACTA ACUST UNITED AC 2019. [DOI: 10.15789/2220-7619-2018-4-6.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - F. Maurer
- Nationales Referenzzentrum für Mykobakterien, Borstel
| | | | | | | | - D. Hillemann
- Nationales Referenzzentrum für Mykobakterien, Borstel
| | | | - K. Kranzer
- Nationales Referenzzentrum für Mykobakterien, Borstel
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12
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Maurer FP, Pohle P, Kernbach M, Sievert D, Hillemann D, Rupp J, Hombach M, Kranzer K. Differential drug susceptibility patterns of Mycobacterium chimaera and other members of the Mycobacterium avium-intracellulare complex. Clin Microbiol Infect 2018; 25:379.e1-379.e7. [PMID: 29906595 DOI: 10.1016/j.cmi.2018.06.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To determine MIC distributions for Mycobacterium chimaera, Mycobacterium intracellulare, Mycobacterium colombiense and Mycobacterium avium, and to derive tentative epidemiological cut-off (ECOFF) values. METHODS A total of 683 bacterial isolates (M. chimaera, n = 203; M. intracellulare, n = 77; M. colombiense, n = 68; M. avium, n = 335) from 627 patients were tested by broth microdilution according to CLSI protocol M24-A2 on Sensititre RAPMYCOI plates. MICs were interpreted based on CLSI breakpoints for clarithromycin, and tentative breakpoints for amikacin, moxifloxacin and linezolid. Tentative ECOFFs were determined by visual approximation and the ECOFFinder algorithm. RESULTS Modal MIC, MIC50 and MIC90 values were within ± one dilution step from the respective aggregated data set for 47/48 (97.9%), 48/48 (100%) and 48/48 (100%) species-drug combinations. Clarithromycin wild-type populations were mostly classified as susceptible (MIC90 4-8 mg/L; S ≤8 mg/L). Rifabutin MICs were lower than those of rifampicin. Tentative moxifloxacin, linezolid and amikacin breakpoints split wild-type populations. No ECOFFs could be set for rifampicin, ethambutol, ciprofloxacin, isoniazid, trimethoprim/sulfamethoxazole and doxycycline because of truncation of MIC distributions. Agreement between the visually determined and the modelled 97.5% ECOFFs was 90.9%. All 99.0% ECOFFs were one titre step higher than by visual approximation. CONCLUSIONS Drug susceptibility patterns of M. chimaera are comparable to those of closely related species. Except for clarithromycin, breakpoints for Mycobacterium avium-intracellulare complex should be re-evaluated. Statistical determination of the 99.0% ECOFF may be superior to visual approximation.
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Affiliation(s)
- F P Maurer
- Research Centre Borstel, National Reference Centre for Mycobacteria, Borstel, Germany.
| | - P Pohle
- Research Centre Borstel, National Reference Centre for Mycobacteria, Borstel, Germany
| | - M Kernbach
- Research Centre Borstel, National Reference Centre for Mycobacteria, Borstel, Germany
| | - D Sievert
- Research Centre Borstel, National Reference Centre for Mycobacteria, Borstel, Germany
| | - D Hillemann
- Research Centre Borstel, National Reference Centre for Mycobacteria, Borstel, Germany
| | - J Rupp
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - M Hombach
- Roche Diagnostics International AG, Rotkreuz, Switzerland
| | - K Kranzer
- Research Centre Borstel, National Reference Centre for Mycobacteria, Borstel, Germany
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13
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Khan PY, Crampin AC, Mzembe T, Koole O, Fielding KL, Kranzer K, Glynn JR. Does antiretroviral treatment increase the infectiousness of smear-positive pulmonary tuberculosis? Int J Tuberc Lung Dis 2018; 21:1147-1154. [PMID: 29037295 PMCID: PMC5644739 DOI: 10.5588/ijtld.17.0162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding of the effects of human immunodeficiency virus (HIV) infection and antiretroviral treatment (ART) on Mycobacterium tuberculosis transmission dynamics remains limited. We undertook a cross-sectional study among household contacts of smear-positive pulmonary tuberculosis (TB) cases to assess the effect of established ART on the infectiousness of TB. METHOD Prevalence of tuberculin skin test (TST) positivity was compared between contacts of index cases aged 2-10 years who were HIV-negative, HIV-positive but not on ART, on ART for <1 year and on ART for 1 year. Random-effects logistic regression was used to take into account clustering within households. RESULTS Prevalence of M. tuberculosis infection in contacts of HIV-negative patients, HIV-positive patients on ART 1 year and HIV-positive patients not on ART/on ART <1 year index cases was respectively 44%, 21% and 22%. Compared to contacts of HIV-positive index cases not on ART or recently started on ART, the odds of TST positivity was similar in contacts of HIV-positive index cases on ART 1 year (adjusted OR [aOR] 1.0, 95%CI 0.3-3.7). The odds were 2.9 times higher in child contacts of HIV-negative index cases (aOR 2.9, 95%CI 1.0-8.2). CONCLUSIONS We found no evidence that established ART increased the infectiousness of smear-positive, HIV-positive index cases.
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Affiliation(s)
- P Y Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, Karonga Prevention Study, Chilumba, Malawi
| | - A C Crampin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, Karonga Prevention Study, Chilumba, Malawi
| | - T Mzembe
- Karonga Prevention Study, Chilumba, Malawi
| | - O Koole
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - K L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - K Kranzer
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, National and Supranational Mycobacterium Reference Laboratory, Forschungszentrum Borstel, Germany
| | - J R Glynn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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14
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Hofmann-Thiel S, Hoffmann H, Hillemann D, Rigouts L, Van Deun A, Kranzer K. How should discordance between molecular and growth-based assays for rifampicin resistance be investigated? Int J Tuberc Lung Dis 2018. [PMID: 28633695 DOI: 10.5588/ijtld.17.0140] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Molecular tests to detect the presence of Mycobacterium tuberculosis and genetic polymorphisms in the rpoB gene conferring resistance to rifampicin (RMP) have become integral parts of tuberculosis diagnostics worldwide. These assays are often performed sequentially or in parallel to phenotypic drug susceptibility testing. Discordances between molecular and phenotypic tests invariably occur. Root causes range from pre-, post- and analytic errors to co-existence of non-tuberculous mycobacteria, silent mutations, mutations outside the 81 base-pair RMP resistance-determining region, non-canonical mutations conferring increased minimal inhibitory concentrations below the critical concentration in some phenotypic drug susceptibility tests, and heteroresistance. Resolving discordant results is challenging. This guide aims to assist both clinicians and microbiologists in interpreting discordances by providing a structured approach to manage further investigations. Case scenarios are discussed, including the likelihood of occurrence.
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Affiliation(s)
- S Hofmann-Thiel
- SYNLAB Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting
| | - H Hoffmann
- SYNLAB Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting
| | - D Hillemann
- National and Supranational Reference Laboratory, Leibniz Research Centre Borstel, Borstel, Germany
| | | | - A Van Deun
- Institute of Tropical Medicine, Antwerp, Belgium, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K Kranzer
- National and Supranational Reference Laboratory, Leibniz Research Centre Borstel, Borstel, Germany , London School of Hygiene & Tropical Medicine, London, UK
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15
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Lange B, Khan P, Kalmambetova G, Al-Darraji HA, Alland D, Antonenka U, Brown T, Balcells ME, Blakemore R, Denkinger CM, Dheda K, Hoffmann H, Kadyrov A, Lemaitre N, Miller MB, Nikolayevskyy V, Ntinginya EN, Ozkutuk N, Palacios JJ, Popowitch EB, Porcel JM, Teo J, Theron G, Kranzer K. Diagnostic accuracy of the Xpert ® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis. Int J Tuberc Lung Dis 2018; 21:493-502. [PMID: 28399963 DOI: 10.5588/ijtld.16.0702] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis. DESIGN Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated. RESULTS Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87). Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples. CONCLUSION Xpert CT values and smear status were strongly associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen.
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Affiliation(s)
- B Lange
- Centre for Chronic Immunodeficiency, Division of Infectious Diseases, Department of Internal Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - P Khan
- London School of Hygiene & Tropical Medicine, London, UK
| | - G Kalmambetova
- National TB Reference Laboratory, National Centre of Phthisiology, Bishkek, Kyrgyzstan
| | - H A Al-Darraji
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - D Alland
- Division of Infectious Disease, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - U Antonenka
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany
| | - T Brown
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - M E Balcells
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Blakemore
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - C M Denkinger
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - K Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - H Hoffmann
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany
| | - A Kadyrov
- National TB Reference Laboratory, National Centre of Phthisiology, Bishkek, Kyrgyzstan
| | - N Lemaitre
- Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire, Université de Lille-Nord de France, Unité Mixte de Recherche 8204, F-59021, Institut National de la Santé et de la Recherche Médicale U1019, Lille, France
| | - M B Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - V Nikolayevskyy
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany, Department of Medicine, Imperial College London, UK
| | - E N Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - N Ozkutuk
- Celal Bayar University Faculty of Medicine, Department of Medical Microbiology, Manisa, Turkey
| | - J J Palacios
- Regional Mycobacteria Reference Center, Hospital Universitario Central de Asturias, Oviedo
| | - E B Popowitch
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - J M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain
| | - J Teo
- Microbiology Unit, Department of Laboratory Medicine, National University Hospital, Singapore
| | - G Theron
- Microbiology Unit, Department of Laboratory Medicine, National University Hospital, Singapore
| | - K Kranzer
- Department of Science & Technology/National Research Foundation of Excellence for Biomedical Tuberculosis Research, and South African Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, National Reference Laboratory for Mycobacteria, FZ Borstel, Germany
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16
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Olaru ID, Patel H, Kranzer K, Perera N. Turnaround time of whole genome sequencing for mycobacterial identification and drug susceptibility testing in routine practice. Clin Microbiol Infect 2017; 24:659.e5-659.e7. [PMID: 29030167 DOI: 10.1016/j.cmi.2017.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/30/2017] [Accepted: 10/01/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Until recently whole genome sequencing (WGS) for mycobacteria has been restricted mostly to the research setting. However, in 2017 Public Health England has implemented WGS for routine mycobacterial identification and susceptibility testing for Mycobacterium tuberculosis. Our objective was to evaluate the impact of this change on the laboratory turnaround times and availability of results. METHODS Over the years 2016 and 2017, the period 1 January to 30 April was selected to represent before and after implementation of WGS. Prior to 2017, line probe assays were used for mycobacterial species identification. Turnaround times for the different steps of the diagnostic process were evaluated for all positive mycobacterial cultures that were sent from our hospital to the Reference Laboratory during the study period. RESULTS A total of 161 positive mycobacterial cultures were sent to the Reference Laboratory. Half of the isolates (n=81/161, 50%) were M. tuberculosis and 80/161 (50%) were non-tuberculous mycobacteria. The median number of workdays for mycobacterial species identification was 1 day (interquartile range (IQR) 1-3) in 2016 and 6 days (IQR 5-7) in 2017, p <0.001. For M. tuberculosis complex, the median time to drug susceptibility testing results, either molecular or phenotypic, was 12 days (IQR 11-18) in 2016 and 8 days (IQR 7-10) in 2017, p <0.001. CONCLUSIONS Routine WGS performed well in this setting for mycobacterial identification and susceptibility testing for M. tuberculosis and decreased time to drug susceptibility testing results. There was an increase in turnaround times for species identification using WGS, when compared with the previous methods.
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Affiliation(s)
- I D Olaru
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - H Patel
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - K Kranzer
- National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel, Germany; London School of Hygiene and Tropical Medicine, London, UK
| | - N Perera
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
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Wilmore SMS, Kranzer K, Williams A, Makamure B, Nhidza AF, Mayini J, Bandason T, Metcalfe J, Nicol MP, Balakrishnan I, Ellington MJ, Woodford N, Hopkins S, McHugh TD, Ferrand RA. Carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in HIV-infected children in Zimbabwe. J Med Microbiol 2017; 66:609-615. [PMID: 28513417 PMCID: PMC5817228 DOI: 10.1099/jmm.0.000474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Antimicrobial resistance is an emerging global health issue. Data on the epidemiology of multidrug-resistant organisms are scarce for Africa, especially in HIV-infected individuals who often have frequent contact with healthcare. We investigated the prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage in stool among HIV-infected children attending an HIV outpatient department in Harare, Zimbabwe. Methods We recruited children who were stable on antiretroviral therapy (ART) attending a HIV clinic from August 2014 to June 2015. Information was collected on antibiotic use and hospitalization. Stool was tested for ESBL-E through combination disc diffusion. API20E identification and antimicrobial susceptibility was performed on the positive samples followed by whole genome sequencing. Results Stool was collected from 175/202 (86.6 %) children. Median age was 11 [inter-quartile range (IQR) 9–12] years. Median time on ART was 4.6 years (IQR 2.4–6.4). ESBL-Es were found in 24/175 samples (13.7 %); 50 % of all ESBL-Es were resistant to amoxicillin-clavulanate, 100 % to co-trimoxazole, 45.8 % to chloramphenicol, 91.6 % to ceftriaxone, 20.8 % to gentamicin and 62.5 % to ciprofloxacin. ESBL-Es variously encoded CTX-M, OXA, TEM and SHV enzymes. The odds of ESBL-E carriage were 8.5 times (95 % CI 2.2–32.3) higher in those on ART for less than one year (versus longer) and 8.5 times (95 % CI 1.1–32.3) higher in those recently hospitalized for a chest infection. Conclusion We found a 13.7 % prevalence of ESBL-E carriage in a population where ESBL-E carriage has not been described previously. Antimicrobial resistance (AMR) in Africa merits further study, particularly given the high HIV prevalence and limited diagnostic and therapeutic options available.
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Affiliation(s)
- S M S Wilmore
- Royal Free Hospital NHS Trust, London, UK.,London School of Hygiene and Tropical Medicine, London, UK.,UCL Centre for Clinical Microbiology, University College London, London, UK
| | - K Kranzer
- London School of Hygiene and Tropical Medicine, London, UK.,National German Mycobacterium Reference, Borstel, Germany
| | - A Williams
- Royal Free Hospital NHS Trust, London, UK
| | - B Makamure
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - A F Nhidza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - J Mayini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - T Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - J Metcalfe
- University of California, San Francisco, USA
| | - M P Nicol
- University of Cape Town, National Health Laboratory Service, Cape Town, South Africa
| | | | | | | | - S Hopkins
- Royal Free Hospital NHS Trust, London, UK.,Public Health England, London, UK
| | - T D McHugh
- UCL Centre for Clinical Microbiology, University College London, London, UK
| | - R A Ferrand
- London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
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18
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Khan PY, Glynn JR, Fielding KL, Mzembe T, Mulawa D, Chiumya R, Fine PEM, Koole O, Kranzer K, Crampin AC. Risk factors for Mycobacterium tuberculosis infection in 2-4 year olds in a rural HIV-prevalent setting. Int J Tuberc Lung Dis 2017; 20:342-9. [PMID: 27046715 PMCID: PMC4743681 DOI: 10.5588/ijtld.15.0672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Mycobacterium tuberculosis infection in children acts as a sentinel for infectious tuberculosis. OBJECTIVE: To assess risk factors associated with tuberculous infection in pre-school children. METHOD: We conducted a population-wide tuberculin skin test (TST) survey from January to December 2012 in Malawi. All children aged 2–4 years residing in a demographic surveillance area were eligible. Detailed demographic data, including adult human immunodeficiency virus (HIV) status, and clinical and sociodemographic data on all diagnosed tuberculosis (TB) patients were available. RESULTS: The prevalence of M. tuberculosis infection was 1.1% using a TST induration cut-off of 15 mm (estimated annual risk of infection of 0.3%). The main identifiable risk factors were maternal HIV infection at birth (adjusted OR [aOR] 3.6, 95%CI 1.1–12.2), having three or more adult members in the household over a lifetime (aOR 2.4, 95%CI 1.2–4.8) and living in close proximity to a known case of infectious TB (aOR 1.6, 95%CI 1.1–2.4), modelled as a linear variable across categories (>200 m, 100–200 m, <100 m, within household). Less than 20% of the infected children lived within 200 m of a known diagnosed case. CONCLUSION: Household and community risk factors identified do not explain the majority of M. tuberculosis infections in children in our setting.
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Affiliation(s)
- P Y Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WD1E 7HT, UK; Karonga Prevention Study, Chilumba, Malawi.
| | - J R Glynn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - K L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - T Mzembe
- Karonga Prevention Study, Chilumba, Malawi
| | - D Mulawa
- Karonga Prevention Study, Chilumba, Malawi
| | - R Chiumya
- Karonga Prevention Study, Chilumba, Malawi
| | - P E M Fine
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - O Koole
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Karonga Prevention Study, Chilumba, Malawi
| | - K Kranzer
- National and Supranational Mycobacterium Reference Laboratory, Forschungszentrum Borstel, Borstel, Germany
| | - A C Crampin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Karonga Prevention Study, Chilumba, Malawi
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Stagg HR, Harris RJ, Hatherell HA, Obach D, Zhao H, Tsuchiya N, Kranzer K, Nikolayevskyy V, Kim J, Lipman MC, Abubakar I. What are the most efficacious treatment regimens for isoniazid-resistant tuberculosis? A systematic review and network meta-analysis. Thorax 2016; 71:940-9. [PMID: 27298314 PMCID: PMC5036252 DOI: 10.1136/thoraxjnl-2015-208262] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/30/2016] [Indexed: 12/02/2022]
Abstract
Introduction Consensus on the best treatment regimens for patients with isoniazid-resistant TB is limited; global treatment guidelines differ. We undertook a systematic review and meta-analysis using mixed-treatment comparisons methodology to provide an up-to-date summary of randomised controlled trials (RCTs) and relative regimen efficacy. Methods Ovid MEDLINE, the Web of Science and EMBASE were mined using search terms for TB, drug therapy and RCTs. Extracted data were inputted into fixed-effects and random-effects models. ORs for all possible network comparisons and hierarchical rankings for different regimens were obtained. Results 12 604 records were retrieved and 118 remained postextraction, representing 59 studies—27 standalone and 32 with multiple papers. In comparison to a baseline category that included the WHO-recommended regimen for countries with high levels of isoniazid resistance (rifampicin-containing regimens using fewer than three effective drugs at 4 months, in which rifampicin was protected by another effective drug at 6 months, and rifampicin was taken for 6 months), extending the duration of rifampicin and increasing the number of effective drugs at 4 months lowered the odds of unfavourable outcomes (treatment failure or the lack of microbiological cure; relapse post-treatment; death due to TB) in a fixed-effects model (OR 0.31 (95% credible interval 0.12–0.81)). In a random-effects model all estimates crossed the null. Conclusions Our systematic review and network meta-analysis highlight a regimen category that may be more efficacious than the WHO population level recommendation, and identify knowledge gaps where data are sparse. Systematic review registration number PROSPERO CRD42014015025.
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Affiliation(s)
- H R Stagg
- Research Department of Infection and Population Health, University College London, London, UK
| | - R J Harris
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - H-A Hatherell
- Research Department of Infection and Population Health, University College London, London, UK UCL CoMPLEX, Faculty of Mathematics and Physical Sciences, University College London, London, UK
| | - D Obach
- Research Department of Infection and Population Health, University College London, London, UK
| | - H Zhao
- Respiratory Diseases Department, National Infections Service, Public Health England, London, UK
| | - N Tsuchiya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - K Kranzer
- National and Supranational Mycobacterium Reference Laboratory, Research Centre Borstel, Borstel, Germany
| | - V Nikolayevskyy
- National Mycobacterium Reference Laboratory, Public Health England, London, UK Department of Medicine, Imperial College London, London, UK
| | - J Kim
- Research Department of Infection and Population Health, University College London, London, UK Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - M C Lipman
- UCL Respiratory, Division of Medicine, University College London, London, UK Royal Free London National Health Service Foundation Trust, London, UK
| | - I Abubakar
- Research Department of Infection and Population Health, University College London, London, UK MRC Clinical Trials Unit, University College London, London, UK
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Rawson TM, Abbara A, Kranzer K, Ritchie A, Milburn J, Brown T, Adeboyeku D, Buckley J, Davidson RN, Berry M, Kon OM, John L. P264 A multi-centre review of the management of pulmonary Non-Tuberculous Mycobacterial (NTM) infection in HIV-negative subjects: Abstract P264 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Kidia K, Kranzer K, Dauya E, Mungofa S, Hatzold K, Busza J, Ncube G, Bandason T, Ferrand R. Provider-initiated HIV testing & counseling (PITC) in children: Tacking the P of PITC. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kidia K, Kranzer K, Dauya E, Mungofa S, Hatzold K, Bandason T, Ferrand R. Missed opportunities for HIV testing of children in a high prevalence setting. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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23
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Kranzer K, Afnan-Holmes H, Tomlin K, Golub JE, Shapiro AE, Schaap A, Corbett EL, Lönnroth K, Glynn JR. The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review [State of the art series. Case finding/screening. Number 2 in the series]. Int J Tuberc Lung Dis 2013; 17:432-46. [DOI: 10.5588/ijtld.12.0743] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Kranzer K, Govindasamy D, van Schaik N, Thebus E, Davies N, Zimmermann M, Jeneker S, Lawn S, Wood R, Bekker LG. Incentivized recruitment of a population sample to a mobile HIV testing service increases the yield of newly diagnosed cases, including those in need of antiretroviral therapy. HIV Med 2012; 13:132-7. [PMID: 22103326 PMCID: PMC3801091 DOI: 10.1111/j.1468-1293.2011.00947.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to compare the yields of newly diagnosed cases of HIV infection and advanced immunodeficiency between individuals attending a mobile HIV counselling and testing (HCT) service as participants in a population-based HIV seroprevalence survey and those accessing the same service as volunteers for routine testing. METHODS The study was conducted in a peri-urban township within the Cape Metropolitan Region, South Africa. Survey participants (recruited testers) were randomly selected, visited at home and invited to attend the mobile HCT service. They received 70 South African Rand food vouchers for participating in the survey, but could choose to test anonymously. The yield of HIV diagnoses was compared with that detected in members of the community who voluntarily attended the same HIV testing facility prior to the survey and did not receive incentives (voluntary testers). RESULTS A total of 1813 individuals were included in the analysis (936 recruited and 877 voluntary testers). The prevalence of newly diagnosed HIV infection was 10.9% [95% confidence interval (CI) 9.0-13.1%] among recruited testers and 5.0% (3.7-6.7%) among voluntary testers. The prevalence of severe immune deficiency (CD4 count ≤ 200 cells/ μL) among recruited and voluntary testers was 17.8% (10.9-26.7%) and 4.6% (0.0-15.4%), respectively. Linkage to HIV care in recruited testers with CD4 counts ≤ 350 cells/ μL was 78.8%. CONCLUSION Compared with routine voluntary HCT, selection and invitation in combination with incentives doubled the yield of newly diagnosed HIV infections and increased the yield almost fourfold of individuals needing antiretroviral therapy. This may be an important strategy to increase community-based HIV diagnosis and access to care.
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Affiliation(s)
- K Kranzer
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
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Kranzer K, Olson L, van Schaik N, Raditlhalo E, Hudson E, Panigrahi P, Bekker LG. Quality of induced sputum using a human-powered nebuliser in a mobile human immunodeficiency virus testing service in South Africa. Int J Tuberc Lung Dis 2011; 15:1077-81. [PMID: 21740671 DOI: 10.5588/ijtld.10.0684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the quality of induced sputum samples using a human-powered (HPN) and an electric-powered nebuliser (EPN). METHODS For each participant two sputum samples were induced using the HPN and the EPN. The sequence of the two nebulisers was allocated at random. The proportion of good quality sputum according to different assessment criteria was compared using an exact McNemar test. The difference in time to expectoration was compared using the Wilcoxon matched-pairs signed-rank test. RESULTS A total of 123 individuals were eligible for the study. Nine individuals refused to participate and five were unable to produce a sputum sample. The proportion of good quality sputum was higher among sputum samples induced by the HPN compared to those obtained using the EPN. The median time to produce a sputum sample was 2.2 min (IQR 1.13-4.1) for the HPN and 2.5 min (IQR 1.4-4.1) for the EPN. CONCLUSION The HPN induced good quality sputum within 3 min. The device operates without electricity and is suitable not only for remote clinics with unreliable electricity, but also for mobile services and community-based intensified tuberculosis (TB) case finding. Further research needs to investigate the yield of TB in sputum samples induced by the HPN.
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Affiliation(s)
- K Kranzer
- Department of Medicine, University of Cape Town, Cape Town, South Africa.
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Frigati LJ, Kranzer K, Cotton MF, Schaaf HS, Lombard CJ, Zar HJ. The impact of isoniazid preventive therapy and antiretroviral therapy on tuberculosis in children infected with HIV in a high tuberculosis incidence setting. Thorax 2011; 66:496-501. [PMID: 21460373 DOI: 10.1136/thx.2010.156752] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Tuberculosis (TB) is a major cause of morbidity and mortality among children infected with HIV. Strategies to prevent TB in children include isoniazid preventive therapy (IPT) and antiretroviral therapy (ART). IPT and ART have been reported to reduce TB incidence in adults but there are few studies in children. OBJECTIVE To investigate the combined effect of IPT and ART on TB risk in children infected with HIV. METHODS A cohort analysis was done within a prospective, double-blinded, placebo-controlled trial of isoniazid (INH) compared with placebo in children infected with HIV in Cape Town, South Africa, a high TB incidence setting. In May 2004 the placebo arm was terminated and all children were switched to INH. ART was not widely available at the start of the study, but children were started on ART following the establishment of the national ART program in 2004. Data were analysed using Cox proportional hazard regression. RESULTS After adjusting for age, nutritional status and immunodeficiency at enrolment, INH alone, ART alone and INH combined with ART reduced the risk of TB disease by 0.22 (95% CI 0.09 to 0.53), 0.32 (95% CI 0.07 to 1.55) and 0.11 (95% CI 0.04 to 0.32) respectively. INH reduced the risk of TB disease in children on ART by 0.23 (95% CI 0.05 to 1.00). CONCLUSIONS The finding that IPT may offer additional protection in children on ART has significant public health implications because this offers a possible strategy for reducing TB in children infected with HIV. Widespread use of this strategy will however require screening of children for active TB disease. Trial registration Trial registration-Clinical Trials NCT00330304.
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Affiliation(s)
- L J Frigati
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch 7700, South Africa.
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Kranzer K, Bauer M, Lipford GB, Heeg K, Wagner H, Lang R. CpG-oligodeoxynucleotides enhance T-cell receptor-triggered interferon-gamma production and up-regulation of CD69 via induction of antigen-presenting cell-derived interferon type I and interleukin-12. Immunology 2000; 99:170-8. [PMID: 10692033 PMCID: PMC2327140 DOI: 10.1046/j.1365-2567.2000.00964.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bacterial cytidine-phosphate-guanosine (CpG-DNA) activates antigen-presenting cells (APC) and drives T helper 1 (Th1)-polarized immune responses in the mouse. Claims have been made that CpG-DNA costimulates murine T cells. We examined the direct and indirect effects of CpG-oligodeoxynucleotides (CpG-ODN) on human T-cell activation. CpG-ODN failed to costimulate purified human T cells activated with alpha-CD3 or alpha-T-cell receptor (TCR)alphabeta antibodies. In contrast, CpG-ODN sequence-specifically caused increased expression of CD69 on CD4 and CD8 T cells when peripheral blood mononuclear cells (PBMC) were stimulated via alpha-CD3. CpG-ODN and alpha-CD3 stimulation synergized to induce interferon-gamma (IFN-gamma) in T cells and natural killer (NK) cells, as shown by intracellular fluorescence-activated cell sorter (FACS) staining. These effects of CpG-ODN on human T cells were caused by the release of IFN type I (IFN-I) and interleukin-12 (IL-12) from PBMC. Enhancement of CD69 expression on alpha-CD3-triggered T cells could be reproduced in a coculture transwell system of purified T cells and PBMC, was inhibited by neutralizing antibodies to IFN-I and could be mimicked by adding exogenous IFN-I. Furthermore, neutralization of either IFN-I or IL-12 diminished, and in combination abolished, IFN-gamma production. These findings show that CpG-ODN potentiate TCR-triggered activation of human T cells in an APC-dependent manner.
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Affiliation(s)
- K Kranzer
- Institute of Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Institute of Medical Microbiology and Hygiene, Philips University, Marburg
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