scholarly journals The Use of Xpert MTB/Rif for Active Case Finding among TB Contacts in North West Province, South Africa

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Limakatso Lebina ◽  
Nigel Fuller ◽  
Tolu Osoba ◽  
Lesley Scott ◽  
Katlego Motlhaoleng ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Turnaround Time ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
North West ◽  
Active Case ◽  
Household Contacts ◽  
Significant Difference ◽  
Diagnosis Rate

Introduction.Tuberculosis is a major cause of morbidity and mortality especially in high HIV burden settings. Active case finding is one strategy to potentially reduce TB disease burden. Xpert MTB/Rif has recently been recommended for diagnosis of TB.Methods.Pragmatic randomized trial to compare diagnosis rate and turnaround time for laboratory testing for Xpert MTB/Rif with TB microscopy and culture in household contacts of patients recently diagnosed with TB.Results.2464 household contacts enrolled into the study from 768 active TB index cases. 1068 (44%) were unable to give sputum, but 24 of these were already on TB treatment. 863 (53%) participants sputum samples were tested with smear and culture and 2.7% (23/863; CI: 1.62–3.78) were diagnosed with active TB. Xpert MTB/Rif was used in 515 (21%) participants; active TB was diagnosed in 1.6% (8/515; CI: 0.52–2.68).Discussion and Conclusions.Additional 31 cases were diagnosed with contact tracing of household members. When Xpert MTB/Rif is compared with culture, there is no significant difference in diagnostic yield.

scholarly journals Expanding Tuberculosis Case Detection by Screening Household Contacts

2005 ◽  
Vol 120 (3) ◽  
pp. 271-277 ◽  
Author(s):  
Mercedes C. Becerra ◽  
Iliana F. Pachao-Torreblanca ◽  
Jaime Bayona ◽  
Rosa Celi ◽  
Sonya S. Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Finding ◽  
Self Report ◽  
Contact Tracing ◽  
Sputum Smear ◽  
Case Detection ◽  
Active Case Finding ◽  
Active Case ◽  
Tb Control ◽  
Household Contacts

Objectives. Tuberculosis (TB) case detection remains low in many countries, compromising the efficacy of TB control efforts. Current global TB control policy emphasizes case finding through sputum smear microscopy for patients who self-report to primary health centers. Our objective was to assess the feasibility and yield of a simple active case finding strategy in a high incidence population in northern Lima, Peru. Methods. We implemented this pilot strategy in one health center's catchment area. Health workers visited household contacts of new TB case subjects to identify symptomatic individuals and collect sputum for screening. Neighboring households were screened in the same manner. Secondary analyses measured risk of TB by ( 1) sputum smear status of the index case subject, ( 2) compliance with testing, and ( 3) risk factors for disease detected through active contact tracing in contrast to self-report. Results. The TB prevalence detected through combined active and passive case finding among 1,094 household contacts was 0.91% (914 per 100,000), much higher than with passive case finding alone (0.18%; 183 per 100,000; p=0.02). Among 2,258 neighbors, the combined strategy detected a TB prevalence of 0.22% (221 per 100,000) in contrast to 0.08% (80 per 100,000) detected through passive case finding alone ( p=0.25). Risk factors for being diagnosed through active case finding in contrast with self-report included age >55 years (odds ratio [OR]=5.5; 95% confidence interval [CI] 1.2, 22.8) and female gender (OR=3.9; 95% CI 0.99, 22.3). Conclusions. Risk of active TB among symptomatic household contacts of active case subjects in this community is very high. Results suggest that contact tracing in such settings may be a powerful means of improving case detection rates for active TB disease.

scholarly journals COVID-19 control strategies and intervention effects in resource limited settings: A modeling study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252570
Author(s):  
Kiran Raj Pandey ◽  
Anup Subedee ◽  
Bishesh Khanal ◽  
Bhagawan Koirala
Keyword(s):  
Control Strategies ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
Resource Limited Settings ◽  
Peak Demand ◽  
Active Case ◽  
Resource Limited ◽  
Base Scenario ◽  
Annual Mortality

Introduction Many countries with weaker health systems are struggling to put together a coherent strategy against the COVID-19 epidemic. We explored COVID-19 control strategies that could offer the greatest benefit in resource limited settings. Methods Using an age-structured SEIR model, we explored the effects of COVID-19 control interventions–a lockdown, physical distancing measures, and active case finding (testing and isolation, contact tracing and quarantine)–implemented individually and in combination to control a hypothetical COVID-19 epidemic in Kathmandu (population 2.6 million), Nepal. Results A month-long lockdown will delay peak demand for hospital beds by 36 days, as compared to a base scenario of no intervention (peak demand at 108 days (IQR 97-119); a 2 month long lockdown will delay it by 74 days, without any difference in annual mortality, or healthcare demand volume. Year-long physical distancing measures will reduce peak demand to 36% (IQR 23%-46%) and annual morality to 67% (IQR 48%-77%) of base scenario. Following a month long lockdown with ongoing physical distancing measures and an active case finding intervention that detects 5% of the daily infection burden could reduce projected morality and peak demand by more than 99%. Conclusion Limited resource settings are best served by a combination of early and aggressive case finding with ongoing physical distancing measures to control the COVID-19 epidemic. A lockdown may be helpful until combination interventions can be put in place but is unlikely to reduce annual mortality or healthcare demand.

scholarly journals Comparison of yield and relative costs of different screening algorithms for tuberculosis in active case-finding: a cross-section study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Zhao ◽  
Canyou Zhang ◽  
Chongguang Yang ◽  
Yinyin Xia ◽  
Jin Xing ◽  
...  
Keyword(s):  
Case Finding ◽  
Active Case Finding ◽  
Face To Face ◽  
Active Case ◽  
Symptom Screening ◽  
Significant Difference ◽  
National Tuberculosis ◽  
Study Population ◽  
The Difference ◽  
The Cost

Abstract Background Part of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China. Methods The study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms. Results Algorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p < 0.01, Kappa 95% CI: 0. 93–0.99) and China NTP (p = 0.03, Kappa 95% CI: 0.96–1.00). There was a significant difference in the total costs among different three algorithms WHO 1c/2/3 (F = 59.13, p < 0.01). No significant difference in the average costs for one active TB case screened and diagnosed through the process among Algorithms 1c/2/3 was evident (F = 2.78, p = 0.07). The average costs for one bacteriological positive case through algorithm WHO 1a was about two times as much as the costs for one active TB case through algorithms WHO 1c/2/3. Conclusions Active case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding.

scholarly journals Cost-effectiveness of active case-finding of household contacts of pulmonary tuberculosis patients in a low HIV, tuberculosis-endemic urban area of Lima, Peru

2017 ◽  
Vol 145 (6) ◽  
pp. 1107-1117 ◽  
Author(s):  
L. SHAH ◽  
M. ROJAS ◽  
O. MORI ◽  
C. ZAMUDIO ◽  
J. S. KAUFMAN ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Test ◽  
Cost Effective ◽  
Case Finding ◽  
Self Report ◽  
Urban Setting ◽  
Active Case Finding ◽  
Active Case ◽  
Household Contacts ◽  
Life Years

SUMMARYWe compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.

scholarly journals TB contact tracing for young children: an Australian cascade of care review

2021 ◽  
Vol 11 (2) ◽  
pp. 91-96
Author(s):  
N. Moyo ◽  
E. L Tay ◽  
A. Nolan ◽  
H. R. Graham ◽  
S. M. Graham ◽  
...  
Keyword(s):  
Young Child ◽  
Preventive Treatment ◽  
Case Finding ◽  
Contact Tracing ◽  
High Yield ◽  
Sputum Smear ◽  
Active Case Finding ◽  
Pulmonary Tb ◽  
Active Case ◽  
Cascade Of Care

OBJECTIVE: To evaluate care cascades for programmatic active case finding and latent TB infection (LTBI) management in young child TB contacts (aged <5 years) in Victoria, Australia.DESIGN: This was a retrospective review of public health surveillance data to identify contacts of all pulmonary TB cases notified from 2016 to 2019.RESULTS: Contact tracing identified 574 young child contacts of 251 pulmonary TB cases. Active TB was found in 28 (4.9%) contacts, none of whom had previously received bacille Calmette-Guérin vaccination, and 529 were tested for TB infection using the tuberculin skin test (TST). The overall TST positivity was 15.3% (95% CI 0.1–0.2). Among the 574 children, 150 (26.1%) were close contacts of sputum smear-positive cases and 25 (16.7%) of these were not referred to TB clinics. Of the 125 referred, 81 were considered to have LTBI, 79 agreed to commence TB preventive treatment (TPT) and 71 (89.9%) completed TPT. Following completion of TPT, no child was subsequently diagnosed with active TB.CONCLUSION: There was a high yield from active case finding and uptake of TPT. Notable losses in the cascade of care occurred around referral to tertiary clinics, but high treatment completion rates and good outcomes were found in those prescribed treatment.

scholarly journals COVID-19 Control Strategies and Intervention Effects in Resource Limited Settings: A Modeling Study

2020 ◽  
Author(s):  
Kiran Raj Pandey ◽  
Anup Subedee ◽  
Bishesh Khanal ◽  
Bhagawan Koirala
Keyword(s):  
Control Strategies ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
Resource Limited Settings ◽  
Peak Demand ◽  
Active Case ◽  
Resource Limited ◽  
Base Scenario ◽  
Annual Mortality

ABSTRACTBackgroundMany countries with weaker health systems are struggling to put together a coherent strategy against the COVID-19 epidemic. We explored COVID-19 control strategies that could offer the greatest benefit in resource limited settings.MethodsUsing an age-structured SEIR model, we explored the effects of COVID-19 control interventions--a lockdown, physical distancing measures, and active case finding (testing and isolation, contact tracing and quarantine)-- implemented individually and in combination to control a hypothetical COVID-19 epidemic in Kathmandu (population 2.6 million), Nepal.ResultsA month-long lockdown that is currently in place in Nepal will delay peak demand for hospital beds by 36 days, as compared to a base scenario of no interventions (peak demand at 108 days (Inter-Quartile Range IQR 97–119); a 2 month long lockdown will delay it by 74 days, without any difference in annual mortality, or healthcare demand volume. Year-long physical distancing measures will reduce peak demand to 36% (IQR 23%-46%) and annual morality to 67% (IQR 48%-77%) of base scenario. Following a month long lockdown with ongoing physical distancing measures and an active case finding intervention that detects 5% of the daily infection burden could reduce projected morality and peak demand by more than 99%.InterpretationLimited resources settings are best served by a combination of early and aggressive case finding with ongoing physical distancing measures to control the COVID-19 epidemic. A lockdown may be helpful until combination interventions can be put in place but is unlikely to reduce annual mortality or healthcare demand.

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