scholarly journals Performance and Impact of GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit® Assays on Tuberculosis Case Detection in Madagascar

2019 ◽  
Author(s):  
Niaina Rakotosamimanana ◽  
Simon Grandjean Lapierre ◽  
Vaomalala Raharimanga ◽  
Mamy Serge Raherison ◽  
Astrid Knoblauch ◽  
...  
Keyword(s):  
National Level ◽  
Scale Up ◽  
Control Program ◽  
Urban Setting ◽  
Smear Microscopy ◽  
Case Detection ◽  
Tuberculosis Case ◽  
Diagnostic Algorithms ◽  
Molecular Assays ◽  
The Impact

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.

scholarly journals Performance and Impact of GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit® Assays on Tuberculosis Case Detection in Madagascar

2019 ◽  
Author(s):  
Niaina Rakotosamimanana ◽  
Simon Grandjean Lapierre ◽  
Vaomalala Raharimanga ◽  
Mamy Serge Raherison ◽  
Astrid Knoblauch ◽  
...  
Keyword(s):  
Scale Up ◽  
High Sensitivity ◽  
Urban Setting ◽  
Smear Microscopy ◽  
Case Detection ◽  
Tuberculosis Case ◽  
Diagnostic Algorithms ◽  
Molecular Assays ◽  
Sub Saharan ◽  
The Impact

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 we measure the impact of both assays and WHO-recommended diagnostic algorithms on additional tuberculosis case notifications. 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). 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.

scholarly journals Performance and Impact of GeneXpert MTB/RIF® and Loopamp MTBC Detection Kit® Assays on Tuberculosis Case Detection in Madagascar

2019 ◽  
Author(s):  
Niaina Rakotosamimanana ◽  
Simon Grandjean Lapierre ◽  
Vaomalala Raharimanga ◽  
Mamy Serge Raherison ◽  
Astrid Knoblauch ◽  
...  
Keyword(s):  
Scale Up ◽  
High Sensitivity ◽  
Urban Setting ◽  
Smear Microscopy ◽  
Case Detection ◽  
Tuberculosis Case ◽  
Diagnostic Algorithms ◽  
Molecular Assays ◽  
Sub Saharan ◽  
The Impact

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 we measure the impact of both assays and WHO-recommended diagnostic algorithms on additional tuberculosis case notifications. 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). 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.

scholarly journals Estimating the Impact of Tuberculosis Case Detection in Constrained Health Systems: An Example of Case-Finding in South Africa

2019 ◽  
Vol 188 (6) ◽  
pp. 1155-1164 ◽  
Author(s):  
Thomas Sumner ◽  
Fiammetta Bozzani ◽  
Don Mudzengi ◽  
Piotr Hippner ◽  
Rein M Houben ◽  
...  
Keyword(s):  
South Africa ◽  
Health Systems ◽  
Case Finding ◽  
Case Detection ◽  
Tuberculosis Case ◽  
The Impact

scholarly journals Weak Intra-facility Referral Linkages: Missed Opportunity for Tuberculosis Case Detection and Treatment in a Tertiary Health Facility in Benue State, Nigeria

2020 ◽  
Vol 3 (4) ◽  
pp. 444-449
Author(s):  
O Audu ◽  
OS Ogiri ◽  
S-A Igbabul ◽  
OO Ijachi ◽  
PO Enokela ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Low Income ◽  
Detection Rate ◽  
Statistical Significance ◽  
Scale Up ◽  
Case Detection ◽  
Care Providers ◽  
Tuberculosis Case ◽  
Female Ratio ◽  
Case Detection Rate

Despite the scale up of quality-assured Tuberculosis diagnostic and treatment strategies over the years, case detection rate remains a serious challenge globally and particularly in Nigeria. Integrated service delivery is essential to addressing some of the challenges, but it's often neglected especially in low income settings. Recognizing these limitations, a 27-months retrospective review of all presumptive Pulmonary Tuberculosis cases sent to the directly observed short course treatment centre of Benue State University Teaching Hospital, a tertiary health institution in north central Nigeria was conducted to assess the source of referrals and diagnostic processes including outcome of the tests. Chi- square (χ2) test was used for test of association between the intra-facility linkages/referrals system and the tuberculosis case detection rate, with statistical significance set at p-value of ≤5%. There were 918 presumptive Tuberculosis cases with male to female ratio (M: F) of 1:1.3. The mean age of patients was 41.0.0 ±18.4 years. Majority (33.7%, n=) of the referrals were from general outpatient department of the hospital, followed by sexually transmitted infection clinic (26.0%) and Paediatrics department (1.6%, n=). The diagnostic positive rate was 145(15.8%). Overall, 295(32.2%) did not collect their results, of these 76(25.8%) were positive and 219(74.2%) were negative. The relationship between the missed cases and the weak intra-facility referral linkages was statistically significant (p=0.000). The hospital management should consider the engagement of all relevant health care providers on efficient two-way referral system towards ensuring adequate Tuberculosis case notification and prompt treatment.

scholarly journals The health system costs of post abortion care in Tanzania

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naomi Lince-Deroche ◽  
George Ruhago ◽  
Philicia W. Castillo ◽  
Patrice Williams ◽  
Projestine Muganyizi ◽  
...  
Keyword(s):  
Health System ◽  
National Level ◽  
Scale Up ◽  
National Health System ◽  
Cost Of Care ◽  
Levels Of Care ◽  
Unintended Pregnancies ◽  
Health System Cost ◽  
Post Abortion ◽  
The Impact

Abstract Background Unsafe abortion is common in Tanzania. Currently, postabortion care (PAC) is legally provided, but there is little information on the national cost. We estimated the health system costs of offering PAC in Tanzania in 2018, at existing levels of care and when hypothetically expanded to meet all need. Methods We employed a bottom-up costing methodology. Between October 2018 and February 2019, face-to-face interviews were conducted with facility administrators and PAC providers in a sample of 40 health facilities located across seven mainland regions and Zanzibar. We collected data on the direct and indirect cost of care, fees charged to patients, and costs incurred by patients for PAC supplies. Sensitivity analysis was used to explore the impact of uncertainty in the analysis. Results Overall, 3850 women received PAC at the study facilities in 2018. At the national level, 77,814 women received PAC, and the cost per patient was $58. The national health system cost for PAC provision at current levels totaled nearly $4.5 million. Meeting all need for PAC would increase costs to over $11 million. Public facilities bore the majority of PAC costs, and facilities recovered just 1% of costs through charges to patients. On average PAC patients incurred $7 in costs ($6.17 for fees plus $1.35 in supplies). Conclusions Resources for health care are limited. While working to scale up access to PAC services to meet women’s needs, Tanzanian policymakers should consider increasing access to contraception to prevent unintended pregnancies.

scholarly journals Rapid Improvement in Passive Tuberculosis Case Detection and Tuberculosis Treatment Outcomes After Implementation of a Bundled Laboratory Diagnostic and On-Site Training Intervention Targeting Mid-Level Providers

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Yukari C. Manabe ◽  
Stella Zawedde-Muyanja ◽  
Sarah M. Burnett ◽  
Frank Mugabe ◽  
Sarah Naikoba ◽  
...  
Keyword(s):  
Public Health ◽  
Treatment Outcomes ◽  
Training Intervention ◽  
Case Detection ◽  
Rapid Improvement ◽  
Tuberculosis Case ◽  
Healthcare Facilities ◽  
Tb Diagnostics ◽  
The Impact ◽  
Site Training

Abstract Background.  Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the public health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods.  Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare facilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results.  From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04% higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95% confidence interval [CI], 5.60–28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76% higher in the intervention than in the control facilities (adjusted OR [AOR], 7.59; 95% CI, 2.19–26.33). After adjusting for the factors above, as well as human immunodeficiency virus and TB retreatment status, the proportion of TB cases who completed treatment was 29.16% higher (AOR, 4.89; 95% CI, 2.24–10.67) and the proportion of TB cases who were lost to follow-up was 66.98% lower (AOR, 0.04; 95% CI, 0.01–0.09). When compared with baseline performance, the intervention facilities had a significantly higher proportion of presumptive TB cases with a sputum examination (64.70% vs 3.44%; OR, 23.95; 95% CI, 12.96–44.25), and these facilities started 56.25% more smear-positive TB cases on treatment during the project period (AOR, 15.36; 95% CI, 6.57–35.91). Conclusions.  Optimizing the existing healthcare workforce through a bundled diagnostics and on-site training intervention for nonphysician healthcare workers will rapidly improve TB case detection and outcomes towards global targets.

scholarly journals Analysing the socio-technical transition to conservation agriculture in Uganda through the lens of the multi-level perspective

2020 ◽  
Author(s):  
Sara Helen Kaweesa ◽  
Hamid El Bilali ◽  
Willibald Loiskandl
Keyword(s):  
National Level ◽  
Scale Up ◽  
Conservation Agriculture ◽  
Scientific Publications ◽  
Conventional Agriculture ◽  
Legal Standards ◽  
Research Findings ◽  
Multi Level ◽  
Civic Awareness ◽  
The Impact

Abstract Conservation agriculture (CA) is based on three principles, namely minimum tillage, crop rotations and maintaining a soil cover. The research used the multi-Level perspective on socio-technical transitions to analyse the dynamics of CA in Uganda. The analysis of the CA niche is structured along the socio-technical regimes and explores the impact of the transition. Data were gathered from Alebtong, Dokolo and Lira districts in mid-Northern Uganda. The results indicate a steady transition towards CA that can be supported to eventually scale up. The legitimisation process of CA transition involved wider implementation by farmers on their fields, validation through adoption by the wider communities and at the national level. The process seeks policy and institutional promotion, more scientific publications of local research findings, validation by legal standards and judicial reasoning, raising civic awareness, stakeholder dialogue and mobilisation of political will to advance the purposes of CA in contrast to conventional agriculture. CA caused changes in practices, perceptions and motivation among the niche actors with respect to agricultural sustainability. However, scaling up could further be enhanced when market policies, credit and financial environment are reconciled.

scholarly journals Are neighbourhoods of tuberculosis cases a high-risk population for active intervention? A protocol for tuberculosis active case finding

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256043
Author(s):  
Bachti Alisjahbana ◽  
Raspati Cundarani Koesoemadinata ◽  
Panji Fortuna Hadisoemarto ◽  
Bony Wiem Lestari ◽  
Sri Hartati ◽  
...  
Keyword(s):  
Scale Up ◽  
Control Program ◽  
Urban Setting ◽  
High Risk Population ◽  
Microbiological Analysis ◽  
X Ray ◽  
Tb Control ◽  
Chest X Ray ◽  
Tb Control Program ◽  
Index Cases

Background Indonesia has the second largest tuberculosis (TB) burden globally. Attempts to scale-up TB control efforts have focused on TB households. However, in most high burden settings, considerable Mycobacterium tuberculosis (Mtb) transmission occurs outside TB households. A better understanding of transmission dynamics in an urban setting in Indonesia will be crucial for the TB Control Program in scaling up efforts towards elimination of TB in a more targeted way. Therefore, the study aims to measure TB prevalence and incidence in household contacts and neighbourhoods in the vicinity of known TB cases and to assess their genomic and epidemiological relatedness. Methods and analysis Individuals (~1000) living in the same household as a case diagnosed with pulmonary TB (n = 250) or in a neighbouring household (~4500 individuals) will be screened for TB symptoms and by chest x-ray. Two sputum samples will be collected for microbiological analysis from anyone with a productive cough. Any person found to have TB will be treated by the National TB Control Program. All those with no evidence of TB disease will have a repeat screen at 12 months. Whole-genome sequencing (WGS) and social network analysis (SNA) will be conducted on Index cases and contacts diagnosed with TB.

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