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

F1000Research ◽  
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.

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

F1000Research ◽  
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.

Performance of Xpert MTB/RIF Ultra for tuberculosis diagnosis in the context of passive and active case finding

2021 ◽  
pp. 2100257
Author(s):  
Belén Saavedra ◽  
Edson Mambuque ◽  
Dinis Nguenha ◽  
Neide Gomes ◽  
Shilzia Munguane ◽  
...  
Keyword(s):  
Health Care Services ◽  
Field Evaluation ◽  
Case Finding ◽  
Smear Microscopy ◽  
Active Case Finding ◽  
Active Case ◽  
Care Services ◽  
Previously Treated ◽  
Tuberculosis Diagnosis ◽  
Composite Reference Standard

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.

scholarly journals Mobile community-based active case-finding for tuberculosis among older populations in rural Cambodia

2019 ◽  
Vol 23 (10) ◽  
pp. 1107-1114 ◽  
Author(s):  
O. Camelique ◽  
S. Scholtissen ◽  
J.-P. Dousset ◽  
M. Bonnet ◽  
M. Bastard ◽  
...  
Keyword(s):  
Risk Group ◽  
Treatment Success ◽  
Case Finding ◽  
High Risk Group ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case ◽  
Tb Treatment ◽  
Mobile Community ◽  
Older Populations

OBJECTIVE: To systematically screen older rural populations in Cambodia for tuberculosis (TB) and develop an effective active case-finding (ACF) model for this TB high-risk group.DESIGN: A retrospective study using routinely collected programmatic data on community-based ACF among people aged ≥55 years using TB symptoms and systematic chest radiography (CXR) screening, followed by Xpert® MTB/RIF testing for participants with positive screening results and TB culture for certain Xpert-negative specimens.RESULTS: Of 22 101 participants included in the analysis, 7469 (33.8%) were screening-positive and 5960 (27.0%) underwent Xpert testing. Pulmonary TB was identified in 482 (2.2%) individuals: 288 (1.3%) were bacteriologically confirmed (253 using Xpert, 35 using culture) and 194 (0.9%) were clinically diagnosed. Eighty-seven people needed to be screened in order to diagnose one Xpert-positive case. Among the Xpert-positive cases, only 31.6% (80/253) reported cough ≥2 weeks, and 39.9% (101/253) were asymptomatic but had a CXR suggestive of active TB. Treatment uptake was 97.3% (469/482), and treatment success was 88.0% (424/482).CONCLUSIONS: Community-based ACF was effective in detecting and successfully treating older TB patients, most of whom might otherwise have remained undiagnosed. Mobile CXR appears to be crucial in identifying a high number of asymptomatic, bacteriologically confirmed cases.

scholarly journals 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 ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0171310 ◽  
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

Should active case-finding projects increase the number of tuberculosis cases notified at national level?

2017 ◽  
Vol 21 (4) ◽  
pp. 475-475 ◽  
Author(s):  
L. Blok ◽  
M. I. Bakker ◽  
M. Straetemans ◽  
L. Gerstel ◽  
M. Brouwer ◽  
...  
Keyword(s):  
National Level ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case

scholarly journals Longitudinal-Survival Models for Case-Based Tuberculosis Progression

2021 ◽  
Vol 9 ◽  
Author(s):  
Richard Kiplimo ◽  
Mathew Kosgei ◽  
Ann Mwangi ◽  
Elizabeth Onyango ◽  
Morris Ogero ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Previous History ◽  
Joint Model ◽  
Unfavorable Outcome ◽  
Sputum Smear ◽  
Parameter Estimates ◽  
Time To Event ◽  
Tb Treatment ◽  
History Of ◽  
Previously Treated

Introduction: Tuberculosis (TB) disease continues to be responsible for a high global burden with an estimated 10 million people falling ill each year and an estimated 1.45 million deaths. Widely carried out analyses to utilize routine data coming from this disease, and well-established in literature, have paid attention to time-to-event with sputum smear results being considered only at baseline or even ignored. Also, logistic regression models have been used to demonstrate importance of sputum smear results in patient outcomes. A feature presented by this disease, however, is that each individual patient is usually followed over a period of time with sputum smear results being documented at different points of the treatment curve. This provides both repeated measures and survival times, which may require a joint modeling approach. This study aimed to investigate the association between sputum smear results and the risk of experiencing unfavorable outcome among TB patients and dynamically predict survival probabilities.Method: A joint model for longitudinal and time-to-event data was used to analyze longitudinally measured smear test results with time to experiencing unfavorable outcome for TB patients. A generalized linear mixed-effects model was specified for the longitudinal submodel and cox proportional hazards model for the time-to-event submodel with baseline hazard approximated using penalized B-splines. The two submodels were then assumed to be related via the current value association structure. Bayesian approach was used to approximate parameter estimates using Markov Chain Monte Carlo (MCMC) algorithm. The obtained joint model was used to predict the subject's future risk of survival based on sputum smear results trajectories. Data were sourced from routinely collected TB data stored at National TB Program database.Results: The average baseline age was 35 (SD: 15). Female TB patients constituted 36.42%. Patients with previous history of TB treatment constituted 6.38% (event: 15.25%; no event: 5.29%). TB/HIV co-infection was at 31.23% (event: 47.87%; no event: 29.20%). The association parameter 1.03 (CI[1.03,1.04]) was found to be positive and significantly different from zero, interpreted as follows: The estimate of the association parameter α = 1.033 denoted the log hazard ratio for a unit increase in the log odds of having smear positive results. HIV status (negative) 0.47 (CI [0.46,49]) and history of TB treatment (previously treated) (2.52 CI [2.41,2.63]), sex (female) (0.82 CI [0.78,0.84]), and body mass index (BMI) categories (severe malnutrition being reference) were shown to be statistically significant.Conclusion: Sputum smear result is important in estimating the risk to unfavorable outcome among TB patients. Men, previously treated, TB/HIV co-infected and severely malnourished TB patients are at higher risk of unfavorable outcomes.

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

2018 ◽  
Vol 11 (1) ◽  
pp. 1494897 ◽  
Author(s):  
Hemant Deepak Shewade ◽  
Vivek Gupta ◽  
Srinath Satyanarayana ◽  
Atul Kharate ◽  
K.N. Sahai ◽  
...  
Keyword(s):  
Vulnerable Populations ◽  
Case Finding ◽  
Active Case Finding ◽  
Active Case ◽  
Tuberculosis Diagnosis

scholarly journals Strategies for active detection of tuberculosis in Ukraine: Comparative effectiveness amongst key populations (2014-2018)

2019 ◽  
Vol 13 (07.1) ◽  
pp. 89S-94S
Author(s):  
Natalia Kamenska ◽  
Dilyara Nabirova ◽  
Karapet Davtyan ◽  
Hayk Davtyan ◽  
Rony Zachariah ◽  
...  
Keyword(s):  
Sex Workers ◽  
Case Finding ◽  
Key Populations ◽  
Active Case Finding ◽  
Active Case ◽  
Tb Treatment ◽  
Number Needed To Screen ◽  
Symptom Screening ◽  
Specimen Collection ◽  
Sex With Men

Introduction: Ukraine has gaps in Tuberculosis (TB) service coverage, especially in key populations (KPs). We compared effectiveness of three different strategies for active TB detection among KPs and their linkage to TB treatment during three time periods. Methodology: The KPs included people who inject drugs (PWID), sex workers (SW), men who have sex with men (MSM) and groups at-risk of TB (ex-prisoners, Roma and homeless). The active case finding included decentralized symptom screening and specimen collection (2014, strategy-1), decentralized screening with patient referred for specimen collection (2015-2017, strategy-2) and strategy-2 plus GeneXpert (2018, strategy-3). Results: In total 680,760 KPs were screened, of whom 68% were PWID. TB case detection per 100,000 populations was 1,191 in strategy-1, 302 in strategy-2, and 235 in strategy-3. The number needed to screen (NNS) to identify one case was respectively 84, 332, and 425. TB detection was highest among homeless (range: 1,839-2,297 per 100,000 population). The lowest detection was among the MSM and SW. Between 2014 and 2018, 82-94% of all diagnosed TB patients in KPs started TB treatment. Conclusions: The active case finding in KPs increased detection of TB cases in Ukraine, and the majority of diagnosed KPs initiated TB treatment. Centralization of diagnosis reduced the effectiveness of TB screening. Each region in Ukraine should assess the composition and the needs of KPs which will allow for adoption of specific strategies to detect TB among KPs with high TB prevalence.

scholarly journals Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Shamanthi Jayasooriya ◽  
Francesca Dimambro-Denson ◽  
Claire Beecroft ◽  
Julie Balen ◽  
Babatunde Awokola ◽  
...  
Keyword(s):  
Past History ◽  
Meta Analysis ◽  
Case Series ◽  
Case Finding ◽  
Sub Saharan Africa ◽  
Active Case Finding ◽  
African Countries ◽  
Active Case ◽  
Healthcare Needs ◽  
Sub Saharan

Background: Many patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed. Methods: We searched four databases from inception to April 27, 2020, without language restrictions (PROSPERO: CRD42018100004). We included all adult pulmonary tuberculosis diagnostic studies from sub-Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random-effects meta-analysis to obtain pooled estimates stratified by passive and active case finding. Results: Our search identified 1799 studies, of which 18 studies with 14527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 38.4-56.7) in passive and 92.7% (95% CI 83.1-97.0) in active case finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. Past history of tuberculosis was documented in only 55% of studies, with just five out of 18 reporting any alternative diagnoses. Discussion: Nearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case finding strategies are used. Little is known about the healthcare needs of these patients. Research is required to better characterise these patient populations and plan health system solutions that meet their needs. Funding NIHR, UK MRC

Sign in / Sign up

Export Citation Format

Share Document