Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

We present a field evaluation of the diagnostic accuracy of Xpert MTB/RIF (Xpert) and Xpert MTB/RIF Ultra (Ultra), using two cohorts in a high TB/HIV burden setting in Southern Mozambique. Single respiratory specimens from symptomatic adults accessing health care services (passive case finding (PCF) cohort), and from household and community close contacts (active case finding (ACF) cohort), were tested by smear microscopy, culture, Xpert and Ultra. Liquid and solid culture served as a composite reference standard. We explored trace results’ impact on specificity via their recategorisation to negative (in all and just among those previously treated individuals) A total of 1419 and 252 participants were enrolled in the PCF and ACF cohorts, respectively. For the PCF cohort, Ultra showed higher sensitivity than Xpert overall (0.95 (95% CI: 0.90, 0.98) versus 0.88 (0.82, 0.93); p<0.001) and among smear negative patients (0.63 (0.48, 0.76) and 0.84 (0.71, 0.93). Ultra's specificity was lower than Xpert's (0.98 (0.97, 0.99) versus 0.96 (0.95, 0.97); p=0.008). For ACF, sensitivities were the same (0.67 (95% CI: 0.22,0.96) for both tests), although Ultra detected a higher number of microbiologically confirmed samples than Xpert (4.7% (12/252) versus 2.7% (7/252)). Conditional recategorisation of trace results among previously treated participants maintained differences in specificity in the PCF cohort. These results add evidence on the improved sensitivity of Ultra and support its use in different case finding scenarios.

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Bringing state-of-the-art diagnostics to vulnerable populations: The use of a mobile screening unit in active case finding for tuberculosis in Palawan, the Philippines

PLoS ONE ◽

10.1371/journal.pone.0171310 ◽

2017 ◽

Vol 12 (2) ◽

pp. e0171310 ◽

Cited By ~ 21

Author(s):

Fukushi Morishita ◽

Anna Marie Celina Gonzales Garfin ◽

Woojin Lew ◽

Kyung Hyun Oh ◽

Rajendra-Prasad Yadav ◽

...

Keyword(s):

Vulnerable Populations ◽

State Of The Art ◽

The Philippines ◽

Case Finding ◽

Active Case Finding ◽

Active Case ◽

Screening Unit ◽

Mobile Screening

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Are we missing ‘previously treated’ smear-positive pulmonary tuberculosis under programme settings in India? A cross-sectional study

F1000Research ◽

10.12688/f1000research.18353.1 ◽

2019 ◽

Vol 8 ◽

pp. 338

Author(s):

Hemant Deepak Shewade ◽

Vivek Gupta ◽

Srinath Satyanarayana ◽

Atul Kharate ◽

Lakshmi Murali ◽

...

Keyword(s):

Vulnerable Populations ◽

Past History ◽

National Level ◽

Previous History ◽

Case Finding ◽

Active Case Finding ◽

Active Case ◽

Tb Treatment ◽

History Of ◽

Previously Treated

Background: In 2007, a field observation from India reported 11% misclassification among ‘new’ patients registered under the revised national tuberculosis (TB) control programme. Ten years down the line, it is important to know what proportion of newly registered patients has a past history of TB treatment. Methods: A study was conducted among new smear-positive pulmonary TB patients registered between March 2016 and February 2017 in 18 randomly selected districts to determine the effectiveness of an active case-finding strategy in marginalised and vulnerable populations. We included all patients detected through active case-finding. An equal number of randomly selected patients registered through passive case-finding from marginalised and vulnerable populations in the same districts were included. Before enrolment, we enquired about any history of previous TB treatment through interviews. Results: Of 629 patients, we interviewed 521, of whom, 11% (n=56) had past history of TB treatment (public or private) for at least a month: 13% (34/268) among the active case-finding group and 9% (22/253) among the passive case-finding group (p=0.18). No factors were found to be significantly associated with misclassification. Conclusion: Around one in every ten patients registered as ‘new’ had previous history of TB treatment. Corrective measures need to be implemented, followed by monitoring of any change in the proportion of ‘previously treated’ patients among all registered patients treated under the programme at national level.

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Challenges from Tuberculosis Diagnosis to Care in Community-Based Active Case Finding among the Urban Poor in Cambodia: A Mixed-Methods Study

PLoS ONE ◽

10.1371/journal.pone.0130179 ◽

2015 ◽

Vol 10 (7) ◽

pp. e0130179 ◽

Cited By ~ 26

Author(s):

Natalie Lorent ◽

Kimcheng Choun ◽

Shelly Malhotra ◽

Pichenda Koeut ◽

Sopheak Thai ◽

...

Keyword(s):

Mixed Methods ◽

Urban Poor ◽

Case Finding ◽

Mixed Methods Study ◽

Active Case Finding ◽

Community Based ◽

Active Case ◽

Tuberculosis Diagnosis

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Are we missing ‘previously treated’ smear-positive pulmonary tuberculosis under programme settings in India? A cross-sectional study

F1000Research ◽

10.12688/f1000research.18353.2 ◽

2019 ◽

Vol 8 ◽

pp. 338

Author(s):

Hemant Deepak Shewade ◽

Vivek Gupta ◽

Srinath Satyanarayana ◽

Atul Kharate ◽

Lakshmi Murali ◽

...

Keyword(s):

Vulnerable Populations ◽

Past History ◽

National Level ◽

Previous History ◽

Case Finding ◽

Active Case Finding ◽

Active Case ◽

Tb Treatment ◽

History Of ◽

Previously Treated

Background: In 2007, a field observation from India reported 11% misclassification among ‘new’ patients registered under the revised national tuberculosis (TB) control programme. Ten years down the line, it is important to know what proportion of newly registered patients has a past history of TB treatment for at least one month (henceforth called ‘misclassification’). Methods: A study was conducted among new smear-positive pulmonary TB patients registered between March 2016 and February 2017 in 18 randomly selected districts to determine the effectiveness of an active case-finding strategy in marginalised and vulnerable populations. We included all patients detected through active case-finding. An equal number of randomly selected patients registered through passive case-finding from marginalised and vulnerable populations in the same districts were included. Before enrolment, we enquired about any history of previous TB treatment through interviews. Results: Of 629 patients, we interviewed 521, of whom, 11% (n=56) had past history of TB treatment (public or private) for at least a month: 13% (34/268) among the active case-finding group and 9% (22/253) among the passive case-finding group (p=0.18). No factors were found to be significantly associated with misclassification. Conclusion: Around one in every ten patients registered as ‘new’ had previous history of TB treatment. Corrective measures need to be implemented, followed by monitoring of any change in the proportion of ‘previously treated’ patients among all registered patients treated under the programme at national level.

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