Improving tuberculosis case detection through contact risk stratification by Xpert MTB/RIF Ultra and spatial parameters : Evaluation of an innovative active case finding strategy in Mozambique (Xpatial-TB)
Saavedra, Belén (Hospital Clínic i Provincial de Barcelona)
Nguenha, D. (Centro de Investigação em Saúde de Manhiça (CISM))
de la Torre-Pérez, Laura (Hospital Clínic i Provincial de Barcelona)
Mambuque, E. (Centro de Investigação em Saúde de Manhiça (CISM))
Tembe, G. (Centro de Investigação em Saúde de Manhiça (CISM))
Oliveras, Laura (Institut de Recerca Sant Pau)
Rudd, M. (The University of the South)
Philimone, P. (Centro de Investigação em Saúde de Manhiça (CISM))
Jose, B. (National Tuberculosis Control Programme)
Garcia, J.I. (Population Health Program Texas Biomedical Research Institute)
Gomes, N. (Centro de Investigação em Saúde de Manhiça (CISM))
Munguambe, S. (Centro de Investigação em Saúde de Manhiça (CISM))
Chiconela, H. (National Tuberculosis Control Programme)
Nhanommbe, M. (Centro de Investigação em Saúde de Manhiça (CISM))
Izco, S. (Ministry of Health and Social Welfare)
Acacio, S. (Centro de Investigação em Saúde de Manhiça (CISM))
García-Basteiro, Alberto L. (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	Prompt diagnosis is critical for tuberculosis (TB) control, as it enables early treatment which in turn, reduces transmission and improves treatment outcomes. We investigated the impact on TB diagnosis of introducing Xpert Ultra as the frontline diagnostic test, combined with an innovative active-case finding (ACF) strategy (based on Xpert Ultra semi-quantitative results and spatial parameters), in a semi-rural district of Southern Mozambique. From January-December 2018 we recruited incident TB-cases (index cases, ICs) and their household contacts (HCs). Recruitment of close community contacts (CCs) depended on IC's Xpert Ultra results, and the population density of their area. TB-contacts, either symptomatic or people living with HIV, were asked to provide a spot sputum for lab-testing. Trends on TB case notification were compared to the previous years and to those of two districts in the south of the Maputo province (control area), using an interrupted time series analysis with and without control (CITS/ITS). A total of 1010 TB ICs (37. 1% laboratory-confirmed) were recruited; 3165 HCs and 4730 CCs were screened for TB. Eighty-nine additional TB cases were identified through the ACF intervention (52. 8% laboratory-confirmed). The intervention increased by 8. 2% all forms of TB cases detected in 2018. Xpert Ultra trace positive results accounted for a high proportion of laboratory confirmations in the ACF cohort (51. 1% vs 13. 7% of those passively diagnosed). The Number Needed to Screen to find a TB case differed widely among HCs (55) and CCs (153). During the intervention period, a reversal of the previous negative trend in lab-confirmed case notifications was observed in the district. However, the CITS model did not show any statistically significant difference compared to the control area. Paediatric population benefited the most from the ACF strategy and HCs screening seemed an effective intervention to find microbiological confirmed cases in early stages of the disease.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PLOS Global Public Health, Vol. 4 Núm. 2 February (february 2024) , p. e0002789, ISSN 2767-3375

DOI: 10.1371/journal.pgph.0002789
PMID: 38335231

17 p, 2.0 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats