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Jaswal M, Farooq S, Madhani F, Noorani S, Salahuddin N, Amanullah F, Khowaja S, Safdar N, Khan A, Yuen C, Keshavjee S, Becerra M, Hussain H, Malik AA. Implementing 3HP vs. IPT as TB preventive treatment in Pakistan. Int J Tuberc Lung Dis 2022; 26:741-746. [PMID: 35898140 DOI: 10.5588/ijtld.21.0676] [Citation(s) in RCA: 5] [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
BACKGROUND: We assessed treatment uptake and completion for 6 months of isoniazid (6H) and 3 months of isoniazid plus rifapentine weekly (3HP) in a programmatic setting in Pakistan.METHODS: All household contacts were clinically evaluated to rule out TB disease. 6H was used for TB preventive treatment (TPT) from October 2016 to April 2017; from May to September 2017, 3HP was used for contacts aged ≥2 years. We compared clinical evaluation, TPT uptake and completion rates between contacts aged ≥2 years in the 6H period and in the 3HP period.RESULTS: We identified 3,442 contacts for the 6H regimen. After clinical evaluation, 744/1,036 (72%) started treatment, while 46% completed treatment. In contrast, 3,722 contacts were identified for 3HP. After clinical evaluation, 990/1,366 (72%) started treatment, while 67% completed treatment. Uptake of TPT did not differ significantly between the 6H and 3HP groups (OR 1.03, 95%CI 0.86-1.24). However, people who initiated 3HP had 2.3 times greater odds (95% CI 1.9-2.8) of completing treatment than those who initiated 6H after adjusting for age and sex.CONCLUSION: In programmatic settings in a high-burden country, household contacts of all ages were more likely to complete TPT with shorter weekly regimens, although treatment uptake rate for the two regimens was similar.
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Affiliation(s)
- M Jaswal
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - S Farooq
- TB Control Programme, The Indus Hospital and Health Network, Karachi, Pakistan
| | - F Madhani
- Programmes Unit, Aga Khan Health Services, Karachi, Pakistan
| | - S Noorani
- Monitoring & Evaluation, Public Health England, London, UK
| | - N Salahuddin
- TB Control Programme, The Indus Hospital and Health Network, Karachi, Pakistan
| | - F Amanullah
- TB Control Programme, The Indus Hospital and Health Network, Karachi, Pakistan
| | - S Khowaja
- TB Department, Interactive Research and Development (IRD) Global, Singapore
| | - N Safdar
- TB Department, Interactive Research and Development (IRD) Global, Singapore
| | - A Khan
- TB Department, Interactive Research and Development (IRD) Global, Singapore, TB Department, Harvard Medical School, Boston, MA, Infectious Diseases, Harvard Medical School Center for Global Health Delivery, Boston, MA
| | - C Yuen
- TB Department, Harvard Medical School, Boston, MA, Infectious Diseases, Harvard Medical School Center for Global Health Delivery, Boston, MA
| | - S Keshavjee
- TB Department, Harvard Medical School, Boston, MA, Infectious Diseases, Harvard Medical School Center for Global Health Delivery, Boston, MA, TB Department, Partners In Health, Boston, MA, Infectious Diseases, Brigham and Women´s Hospital, Boston, MA
| | - M Becerra
- TB Department, Harvard Medical School, Boston, MA, Infectious Diseases, Harvard Medical School Center for Global Health Delivery, Boston, MA, TB Department, Partners In Health, Boston, MA, Infectious Diseases, Brigham and Women´s Hospital, Boston, MA
| | - H Hussain
- TB Department, Interactive Research and Development (IRD) Global, Singapore
| | - A A Malik
- TB Department, Interactive Research and Development (IRD) Global, Singapore, Internal Medicine, Yale School of Medicine, New Haven, CT, Yale Institute for Global Health, New Haven, CT, USA
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Madhani F, Maniar RA, Burfat A, Ahmed M, Farooq S, Sabir A, Domki AK, Page-Shipp L, Khowaja S, Safdar N, Khan AJ, Khan PY. Automated chest radiography and mass systematic screening for tuberculosis. Int J Tuberc Lung Dis 2021; 24:665-673. [PMID: 32718398 DOI: 10.5588/ijtld.19.0501] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: Systematic screening for TB using automated chest radiography (ACR) with computer-aided detection software (CAD4TB) has been implemented at scale in Karachi, Pakistan. Despite evidence supporting the use of ACR as a pre-screen prior to Xpert® MTB/RIF diagnostic testing in presumptive TB patients, there has been no data published on its use in mass screening in real-world settings.METHOD: Screening was undertaken using mobile digital X-ray vehicles at hospital facilities and community camps. Chest X-rays were offered to individuals aged ≥15 years, regardless of symptoms. Those with a CAD4TB score of ≥70 were offered Xpert testing. The association between Xpert positivity and CAD4TB scores was examined using data collected between 1 January and 30 June 2018 using a custom-built data collection tool.RESULTS: Of the 127 062 individuals screened, 97.2% had a valid CAD4TB score; 11 184 (9.1%) individuals had a CAD4TB score ≥70. Prevalence of Xpert positivity rose from 0.7% in the <50 category to 23.5% in the >90 category. The strong linear association between CAD4TB score and Xpert positivity was found in both community and hospital settings.CONCLUSION: The strong association between CAD4TB scores and Xpert positivity provide evidence that an ACR-based pre-screening performs well when implemented at scale in a high-burden setting.
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Affiliation(s)
- F Madhani
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - R A Maniar
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - A Burfat
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - M Ahmed
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - S Farooq
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - A Sabir
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - A K Domki
- Provincial TB Control Program, Department of Health, Government of Sindh, Hyderabad, Pakistan
| | | | - S Khowaja
- Global Health Directorate, Indus Health Network, Karachi, Pakistan, Interactive Research and Development, Singapore
| | - N Safdar
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - A J Khan
- Global Health Directorate, Indus Health Network, Karachi, Pakistan, Interactive Research and Development, Singapore
| | - P Y Khan
- Interactive Research and Development, Singapore, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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