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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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Olaru ID, Beliz Meier M, Schumacher SG, Prodanovic N, Kitchen PJ, Mirzayev F, Denkinger CM. Co-administration of treatment for drug-resistant TB and hepatitis C. Int J Tuberc Lung Dis 2023; 27:66-68. [PMID: 36853135 PMCID: PMC9879085 DOI: 10.5588/ijtld.22.0403] [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: 01/14/2023] Open
Affiliation(s)
- I. D. Olaru
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - M. Beliz Meier
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - S. G. Schumacher
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - N. Prodanovic
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - P. J. Kitchen
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - F. Mirzayev
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - C. M. Denkinger
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
,German Center for Infection Research (DZIF), partner site Heidelberg University Hospital, Heidelberg, Germany
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Divala TH, Lewis J, Bulterys MA, Lutje V, Corbett EL, Schumacher SG, MacPherson P. Missed opportunities for diagnosis and treatment in patients with TB symptoms: a systematic review. Public Health Action 2022; 12:10-17. [PMID: 35317535 PMCID: PMC8908873 DOI: 10.5588/pha.21.0022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The identification of patients with symptoms is the foundation of facility-based TB screening and diagnosis, but underdiagnosis is common. We conducted this systematic review with the hypothesis that underdiagnosis is largely secondary to patient drop out along the diagnostic and care pathway. METHODS We searched (up to 22 January 2019) MEDLINE, Embase, and Cinahl for studies investigating patient pathway to TB diagnosis and care at health facilities. We used Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias. We reported proportions of patients with symptoms at each stage of the pathway from symptom screening to treatment initiation. RESULTS After screening 3,558 abstracts, we identified 16 eligible studies. None provided data addressing the full cascade of care from clinical presentation to treatment initiation in the same patient population. Symptom screening, the critical entry point for diagnosis of TB, was not done for 33-96% of participants with symptoms in the three studies that reported this outcome. The proportion of attendees with symptoms offered a diagnostic investigation (data available for 15 studies) was very low with a study level median of 38% (IQR 14-44, range 4-84). CONCLUSIONS Inefficiencies of the TB symptom screen-based patient pathway are a major contributor to underdiagnosis of TB, reflecting inconsistent implementation of guidelines to ask all patients attending health facilities about respiratory symptoms and to offer diagnostic tests to all patients promptly once TB symptoms are identified. Better screening tools and interventions to improve the efficiency of TB screening and diagnosis pathways in health facilities are urgently needed.
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Affiliation(s)
- T H Divala
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, UK
| | - J Lewis
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - M A Bulterys
- Foundation for New Innovative Diagnostics, Geneva, Switzerland
- Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - V Lutje
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - E L Corbett
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, UK
- Foundation for New Innovative Diagnostics, Geneva, Switzerland
| | - S G Schumacher
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - P MacPherson
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Liverpool School of Tropical Medicine, Liverpool, UK
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Schumacher SG, Thangakunam B, Denkinger CM, Oliver AA, Shakti KB, Qin ZZ, Michael JS, Luo R, Pai M, Christopher DJ. Impact of point-of-care implementation of Xpert ® MTB/RIF: product vs. process innovation. Int J Tuberc Lung Dis 2015; 19:1084-90. [DOI: 10.5588/ijtld.15.0120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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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Rocha C, Montoya R, Zevallos K, Curatola A, Ynga W, Franco J, Fernandez F, Becerra N, Sabaduche M, Tovar MA, Ramos E, Tapley A, Allen NR, Onifade DA, Acosta CD, Maritz M, Concha DF, Schumacher SG, Evans CA. The Innovative Socio-economic Interventions Against Tuberculosis (ISIAT) project: an operational assessment. Int J Tuberc Lung Dis 2011; 15 Suppl 2:50-57. [PMID: 21740659 DOI: 10.5588/ijtld.10.0447] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [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 Tuberculosis (TB) affected households in impoverished shantytowns, Lima, Peru. OBJECTIVE To evaluate socio-economic interventions for strengthening TB control by improving uptake of TB care and prevention services. DESIGN Barriers to TB control were characterised by interviews with TB-affected families. To reduce these barriers, a multidisciplinary team offered integrated community and household socio-economic interventions aiming to: 1) enhance uptake of TB care by education, community mobilisation and psychosocial support; and 2) reduce poverty through food and cash transfers, microcredit, microenterprise and vocational training. An interim analysis was performed after the socio-economic interventions had been provided for 2078 people in 311 households of newly diagnosed TB patients for up to 34 months. RESULTS Poverty (46% earned <US$1 per day), depression (40%), stigmatisation (77%), and perceived isolation (39%) were common among TB patients (all P < 0.05 vs. non-patients). The project had 100% recruitment, and involved 97% of TB-affected households in regular visits, 71% in community groups, 78% in psychosocial support and 77% in poverty-reduction interventions. The socio-economic interventions were associated with increases in household contact TB screening (from 82% to 96%); successful TB treatment completion (from 91% to 97%); patient human immunodeficiency virus testing (from 31% to 97%); and completion of preventive therapy (from 27% to 87%; all P < 0.0001). CONCLUSIONS Socio-economic interventions can strengthen TB control activities. KEYWORDS tuberculosis; control; microcredit; poverty;social determinants.
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Affiliation(s)
- C Rocha
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - R Montoya
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru
| | - K Zevallos
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A Curatola
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - W Ynga
- Asociación Benéfica Prisma, Lima, Peru; Microfinanzas Prisma, Lima, Peru
| | - J Franco
- Asociación Benéfica Prisma, Lima, Peru; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - F Fernandez
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru
| | - N Becerra
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru
| | | | - M A Tovar
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - E Ramos
- IFHAD: Innovation For Health And Development, London, UK; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A Tapley
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru
| | - N R Allen
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru
| | - D A Onifade
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru
| | - C D Acosta
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru
| | - M Maritz
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru
| | | | - S G Schumacher
- IFHAD: Innovation For Health And Development, London, UK; Asociación Benéfica Prisma, Lima, Peru; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - C A Evans
- IFHAD: Innovation For Health And Development, London, UK; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Wellcome Centre for Clinical Tropical Medicine and Department of Infection & Immunity, Imperial College, London, UK; and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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