Improving tuberculosis case detection in underdeveloped multi-ethnic regions with high disease burden: a case study of integrated control program in China

Abstract Background Tuberculosis rapid molecular assays, including GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit®, are highly sensitive and specific. Such performance does not automatically translate in improved disease control and highly depends on their use, local epidemiology and the diagnostic algorithms they’re implemented within. We evaluate the performance of both assays and assess their impact on additional cases notification when implemented within WHO recommended tuberculosis diagnostic algorithms in Madagascar. Methods 548 presumptive pulmonary tuberculosis patients were prospectively recruited between November 2013 and December 2014 in Antananarivo, Madagascar, a high TB incidence sub-Saharan African urban setting. Both molecular assays were evaluated as first line or add-on testing following negative smear microscopy. Based on locally defined assay performance characteristics and using country National Tuberculosis Control Program data, we measure the impact of both assays and WHO-recommended diagnostic algorithms on additional tuberculosis case notifications at national level. Results High sensitivity and specificity was confirmed for both GeneXpert MTB/RIF® (86.6% (95% CI 81.1-90.7%) and 97.4% (95% CI 94.9-98.8%)) and Loopamp MTBC Detection Kit® (84.6% (95% CI 78.9-89.0%) and 98.4% (95% CI 96.2-99.4%)). Implementation of GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit® increased tuberculosis diagnostic algorithms sensitivity from 73.6% (95% CI 67.1-79.3%) up to 88.1% (95% CI 82.8-91.9%). This increase was highest when molecular assays were used as add-on testing following negative smear microscopy. As add-on testing, GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit® respectively improved case detection by 23.8% and 21.2% (p<0.05) corresponding to 5375 and 4788 potential additional case per year at national level. Conclusion Including GeneXpert MTB/RIF® or Loopamp MTBC Detection Kit® molecular assays for TB detection on sputum samples from presumptive TB cases can significantly increase case notification in TB diagnostic centers. The TB case detection rate is further increased when those tests are use as second-line follow-on testing following negative smear microscopy results. A country wide scale-up and digital integration of molecular-based TB diagnosis assays shows promises for TB control in Madagascar.

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Active Tuberculosis Case Finding in Port-au-Prince, Haiti: Experiences, Results, and Implications for Tuberculosis Control Programs

Tuberculosis Research and Treatment ◽

10.1155/2016/8020745 ◽

2016 ◽

Vol 2016 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Guesly J. Delva ◽

Ingrid Francois ◽

Cassidy W. Claassen ◽

Darwin Dorestan ◽

Barbara Bastien ◽

...

Keyword(s):

Case Finding ◽

Case Detection ◽

Tuberculosis Case ◽

Community Screening ◽

Control Programs ◽

Number Needed To Screen ◽

Laboratory Services ◽

Smear Negative ◽

Hiv Negative

Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources.Methods.Mache Chache(“Go and Seek”) was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance.Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities.Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment.

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576 PREDICTORS OF HIGH DISEASE BURDEN IN CHILDREN WITH ACUTE RECURRENT OR CHRONIC PANCREATITIS*

Gastroenterology ◽

10.1016/s0016-5085(21)01016-7 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-112-S-113

Author(s):

Aliye Uc ◽

Laura Rubin ◽

Gretchen Cress ◽

Ying Yuan ◽

Mark Lowe

Keyword(s):

Chronic Pancreatitis ◽

Disease Burden ◽

High Disease Burden

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Genomics research in Africa and its impact on global health: insights from African researchers

Global Health Epidemiology and Genomics ◽

10.1017/gheg.2018.3 ◽

2018 ◽

Vol 3 ◽

Cited By ~ 5

Author(s):

N. S. Munung ◽

B. M. Mayosi ◽

J. de Vries

Keyword(s):

Global Health ◽

Disease Surveillance ◽

Disease Burden ◽

Research Priorities ◽

Treatment And Prevention ◽

Genomics Research ◽

African Populations ◽

Research Findings ◽

Depth Interviews ◽

High Disease Burden

Africa may be heading for an era of genomics medicine. There are also expectations that genomics may play a role in reducing global health inequities. However, the near lack of genomics studies on African populations has led to concerns that genomics may widen, rather than close, the global health inequity gap. To prevent a possible genomics divide, the genomics ‘revolution’ has been extended to Africa. This is motivated, in part, by Africa's rich genetic diversity and high disease burden. What remains unclear, however, are the prospects of using genomics technology for healthcare in Africa. In this qualitative study, we explored the views of 17 genomics researchers in Africa on the prospects and challenges of genomics medicine in Africa. Interviewees were researchers in Africa who were involved in genomics research projects in Africa. Analysis of in-depth interviews suggest that genomics medicine may have an impact on disease surveillance, diagnosis, treatment and prevention. However, Africa's capacity for genomics medicine, current research priorities in genomics and the translation of research findings will be key defining factors impacting on the ability of genomics medicine to improve healthcare in Africa.

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Reducing bias in risk indices for COVID-19

Geospatial health ◽

10.4081/gh.2022.1013 ◽

2022 ◽

Vol 17 (s1) ◽

Author(s):

Michał Paweł Michalak ◽

Jack Cordes ◽

Agnieszka Kulawik ◽

Sławomir Sitek ◽

Sławomir Pytel ◽

...

Keyword(s):

Infectious Diseases ◽

Spatial Heterogeneity ◽

Disease Burden ◽

Risk Indices ◽

Study Evaluation ◽

Dynamical Properties ◽

Time Periods ◽

Regional Disease ◽

Over Time

Spatiotemporal modelling of infectious diseases such as coronavirus disease 2019 (COVID-19) involves using a variety of epidemiological metrics such as regional proportion of cases and/or regional positivity rates. Although observing changes of these indices over time is critical to estimate the regional disease burden, the dynamical properties of these measures, as well as crossrelationships, are usually not systematically given or explained. Here we provide a spatiotemporal framework composed of six commonly used and newly constructed epidemiological metrics and conduct a case study evaluation. We introduce a refined risk estimate that is biased neither by variation in population size nor by the spatial heterogeneity of testing. In particular, the proposed methodology would be useful for unbiased identification of time periods with elevated COVID-19 risk without sensitivity to spatial heterogeneity of neither population nor testing coverage.We offer a case study in Poland that shows improvement over the bias of currently used methods. Our results also provide insights regarding regional prioritisation of testing and the consequences of potential synchronisation of epidemics between regions. The approach should apply to other infectious diseases and other geographical areas.

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