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Berhanu RH, Lebina L, Nonyane BAS, Milovanovic M, Kinghorn A, Connell L, Nyathi S, Young K, Hausler H, Naidoo P, Brey Z, Shearer K, Genade L, Martinson NA. Yield of Facility-based Targeted Universal Testing for Tuberculosis With Xpert and Mycobacterial Culture in High-Risk Groups Attending Primary Care Facilities in South Africa. Clin Infect Dis 2023; 76:1594-1603. [PMID: 36610730 PMCID: PMC10156124 DOI: 10.1093/cid/ciac965] [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: 06/08/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We report the yield of targeted universal tuberculosis (TB) testing of clinic attendees in high-risk groups. METHODS Clinic attendees in primary healthcare facilities in South Africa with one of the following risk factors underwent sputum testing for TB: human immunodeficiency virus (HIV), contact with a TB patient in the past year, and having had TB in the past 2 years. A single sample was collected for Xpert-Ultra (Xpert) and culture. We report the proportion positive for Mycobacterium tuberculosis. Data were analyzed descriptively. The unadjusted clinical and demographic factors' relative risk of TB detected by culture or Xpert were calculated and concordance between Xpert and culture is described. RESULTS A total of 30 513 participants had a TB test result. Median age was 39 years, and 11 553 (38%) were men. The majority (n = 21734, 71%) had HIV, 12 492 (41%) reported close contact with a TB patient, and 1573 (5%) reported prior TB. Overall, 8.3% were positive for M. tuberculosis by culture and/or Xpert compared with 6.0% with trace-positive results excluded. In asymptomatic participants, the yield was 6.7% and 10.1% in symptomatic participants (with trace-positives excluded). Only 10% of trace-positive results were culture-positive. We found that 55% of clinic attendees with a sputum result positive for M. tuberculosis did not have a positive TB symptom screen. CONCLUSIONS A high proportion of clinic attendees with specific risk factors (HIV, close TB contact, history of TB) test positive for M. tuberculosis when universal testing is implemented.
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Affiliation(s)
- Rebecca H Berhanu
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Soweto, South Africa
| | - Bareng A S Nonyane
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
| | - Minja Milovanovic
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Soweto, South Africa
| | - Anthony Kinghorn
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Soweto, South Africa
| | | | | | | | - Harry Hausler
- TB HIV Care, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Pren Naidoo
- Public Health Management Consultant, Cape Town, South Africa
| | - Zameer Brey
- Bill and Melinda Gates Foundation–South Africa, Johannesburg, South Africa
| | - Kate Shearer
- Department of Medicine, Division of Infectious Diseases, Baltimore, Maryland, USA
- Centre for TB Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leisha Genade
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Soweto, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Soweto, South Africa
- Centre for TB Research, Johns Hopkins University, Baltimore, Maryland, USA
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