Prevalence of urinary tract infections in pregnancy in rural Andean communities of Peru.

BACKGROUND: Urinary tract infections (UTIs) can adversely affect pregnancy, yet their prevalence in rural communities remains poorly understood. OBJECTIVE: For an initial evaluation of the UTI burden among pregnant women in the San Marcos province of rural Andean Peru, we aimed to determine the UTI prevalence in the region. DESIGN: A cross-sectional study was conducted in a subsample of 250 pregnant women enrolled in the Peruvian Andes Multigenerational High Altitude Cohort (ALTO) from 2021 to 2022. METHODS: Structured questionnaires were administered to collect demographic, socioeconomic, maternal health and behavioural data. Urine samples were obtained for dipstick analyses. Descriptive and logistic regression analyses were performed to investigate the association between risk factors and UTI. RESULTS: The study participants had a median age of 28 years (IQR: 22-33). A UTI prevalence of 27.6% (CI: 22.4%-33.5%) was observed, surpassing estimates from other regions of Peru. Notably, nearly all pregnant women (96%) utilised antenatal care (ANC) services at least once, primarily visiting health centres and community health posts where doctors and obstetricians were the main care providers. In this population, none of the risk factors exhibited statistically significant associations with UTIs. CONCLUSION: Our study highlights the prevalence of UTIs among Andean pregnant women in San Marcos and underscores the critical need for routine UTI screening and treatment during ANC visits as recommended by national guidelines. While accessibility to ANC services is not a barrier in this region, enhancing the availability and quality of UTI screening services is crucial.

How Common Are Urinary Tract Infections in Pregnant Women in Rural Areas of the Andes in Peru?Urinary tract infections (UTIs) can cause complications during pregnancy, but we don't know enough about how common they are in rural areas. This study looked at how many pregnant women in San Marcos, a rural area in the Andes of Peru, have UTIs. The goal was to better understand the problem in this community. We studied 250 pregnant women who were part of a larger research project called the Peruvian Andes Multigenerational High Altitude Cohort (ALTO), conducted between 2021 and 2022. The women answered questions about their health, occupation, education and lifestyle. They also provided urine samples, which were tested for UTIs using a dipstick test. The women in this study were, on average, 28 years old. We found that about 28% of the women had a UTI during pregnancy, which is higher than rates reported in other parts of Peru. Almost all of the women (96%) received antenatal care at least once, with most of them going to local health centers or community health posts, where obstetricians provided care. However, even though these women were receiving antenatal care, many were not regularly tested or treated for UTIs. Our study shows that UTIs are common in pregnant women in this region. Since UTIs can lead to serious health problems for both mothers and babies, it's important to make UTI testing a regular part of antenatal care and improve access to treatment in rural communities like San Marcos.

My tuberculosis epidemiology journey: Implications for TB program interventions, activities and strategy.

Key learnings from some landmark studies that the author has been associated with and their implications on program strategies are highlighted. Learnings from prevalence surveys provide justification for active TB Case finding (ACF), role of Chest X-ray screening, justification of the elderly as a key vulnerable population and suggest re-think of the methods of sub-national certification for progress towards tuberculosis free status. Risk of infection studies suggest 14 million people acquiring new tuberculous infection each year in India suggesting a re-think on the targets for TB elimination. Justification is given for 'TB deaths averted' as a parameter for monitoring program impact, reviving risk of infection surveys using CyTB and higher emphasis on careful analysis of routine surveillance data for monitoring epidemiological trends rather than oft-repeated surveys. The modelling outputs suggest higher focus on reducing transmission of infection in urban and reducing treatment delay in rural areas and the need to scale up active case finding and TB preventive treatment in order to achieve End TB targets. Case finding studies justify upfront molecular diagnostics, need to confirm a single sputum result by another specimen or radiology during ACF and futility of X-ray based diagnosis during ACF. High rates of recurrence with intermittent treatment regimen providing evidence in favor of daily regimen, role of family centric approach to nutritional supplementation to prevent TB mortality and reduce TB incidence among household contacts are highlighted besides the need to address high proportion of families suffering catastrophic expenses during pre-treatment period.

Community-Wide Active Case Finding for Tuberculosis: Time to Use the Evidence We Have.

Tuberculosis, caused by the Mycobacterium tuberculosis (Mtb) bacteria, is one of the world's deadliest infectious diseases. Despite being the world's oldest pandemic, tuberculosis is very much a challenge of the modern era. In high-incidence settings, all people are at risk, irrespective of whether they have common vulnerabilities to the disease warranting the current WHO recommendations for community-wide tuberculosis active case finding in these settings. Despite good evidence of effectiveness in reducing tuberculosis transmission, uptake of this strategy has been lacking in the communities that would derive greatest benefit. We consider the various complexities in eliminating tuberculosis from the first principles of the disease, including diagnostic and other challenges that must be navigated under an elimination agenda. We make the case that community-wide tuberculosis active case finding is the best strategy currently available to drive elimination forward in high-incidence settings and that no time should be lost in its implementation. Recognizing that high-incidence communities vary in their epidemiology and spatiosocial characteristics, tuberculosis research and funding must now shift towards radically supporting local implementation and operational research in communities. This "preparing of the ground" for scaling up to community-wide intervention centers the local knowledge and local experience of community epidemiology to optimize implementation practices and accelerate reductions in community-level tuberculosis transmission.

Exploring Active Case Detection Approaches for Leprosy Diagnosis in Varied Endemic Settings: A Comprehensive Scoping Review.

(1) Background: The global burden of leprosy is not shared equally; with the majority of cases being diagnosed in Brazil, India, and Indonesia. Understanding the methods of active case detection (ACD) used in high and low endemic regions is vital for the development of future screening programs. (2) Methods: A systematic search of three databases, PubMed, Embase and Web of Science, was conducted for English language papers, published since the year 2000, which discussed the use of active case detection methods for leprosy screening. The paper utilised the Integrated Screening Action Model (I-SAM) as a tool for the analysis of these methods. (3) Results: 23 papers were identified from 11 different countries. The papers identified 6 different methods of active case detection: Household contact/social contact identification; door-to-door case detection; screening questionnaire distribution; rapid village surveys; school-based screening; and prison-based screening. 15 were located in high endemic regions and 8 of these were located in low endemic regions. (4) Conclusions: For selecting the appropriate methods of active case finding, the leprosy endemicity must be taken into consideration. The findings contribute to policy decision making allowing for more successful future leprosy case detection programs to be designed, ultimately reducing the global burden of the disease, and achieving the WHO's aim of zero leprosy.

Yield of TB screening in prisons in Tajikistan.

BACKGROUND: The rate of TB in prison institutions is estimated to be 23 times higher than in the general population. Limited documentation exists regarding TB screening in Tajikistan's prisons. This study aims to report findings from a TB screening conducted in prison facilities in Tajikistan. METHODS: A systematic TB screening was conducted between July 2022 and September 2023, following a locally adapted algorithm based on WHO recommendations. The screening yield was calculated as the proportion of confirmed TB cases, with categorical variables compared using a χ2 test. RESULTS: A total of 7,223 screenings were conducted, identifying 31 TB cases, including 17 drug-susceptible TB cases, eight drug-resistant TB cases, and six clinically diagnosed cases. The overall screening yield was 0.43%. Notably, the screening yield was 3.4% among individuals with at least one TB symptom and 0.03% among those without TB symptoms (P < 0.001). CONCLUSION: The identified rate of TB in these prisons is five times higher than in the general population. Symptomatic individuals had a higher likelihood of TB diagnosis, and using chest X-rays significantly improved screening yield. We recommend increasing the capacity for chest X-ray testing to enhance TB prevention and control within prison settings.

CONTEXTE: On estime que le taux de TB dans les établissements pénitentiaires est 23 fois plus élevé que dans la population générale. Il existe peu de documentation sur le dépistage de la TB dans les prisons du Tadjikistan. Cette étude vise à rendre compte des résultats d'un dépistage de la TB mené dans des établissements pénitentiaires au Tadjikistan. MÉTHODES: Un dépistage systématique de la TB a été réalisé entre juillet 2022 et septembre 2023, selon un algorithme adapté localement et basé sur les recommandations de l'OMS. Le rendement du dépistage a été calculé comme la proportion de cas confirmés de TB, avec des variables catégorielles comparées à l'aide d'un test χ2. RÉSULTATS: Au total, 7 223 dépistages ont été effectués, permettant d'identifier 31 cas de TB, dont 17 cas de TB sensible aux médicaments, 8 cas de TB résistante aux médicaments et 6 cas diagnostiqués cliniquement. Le rendement global du criblage était de 0,43%. Notamment, le rendement du dépistage était de 3,4% chez les personnes présentant au moins un symptôme de la TB et de 0,03% chez celles ne présentant pas de symptômes de la TB (P < 0,001). CONCLUSION: Le taux de TB identifié dans ces prisons est cinq fois plus élevé que dans la population générale. Les personnes symptomatiques avaient une probabilité plus élevée d'être diagnostiquées comme atteintes de TB, et l'utilisation de radiographies pulmonaires améliorait considérablement le rendement du dépistage. Nous recommandons d'augmenter la capacité de dépistage par radiographie thoracique afin d'améliorer la prévention et le contrôle de la TB en milieu carcéral.

Feasibility of eliminating tuberculosis by shortening the diagnostic delay: A retrospective analysis and modelling study in China during the pre-COVID-19 era.

Objective: Delays in the diagnosis and treatment of pulmonary tuberculosis (PTB) can increase the risk of transmission, thereby posing a significant risk to public health. Early diagnosis is considered to play a crucial role in eliminating TB. Rapid testing, active case finding, and health education are effective strategies for reducing tuberculosis diagnosis delays (TDDs). This study aimed to quantitatively compare the impact of reducing the TDD on incidence rates among student and non-student groups, thus exploring the efficacy of shortening the TDD for ending the TB epidemic and providing a reference for achieving the target incidence rate for ending TB. Methods: We used unsupervised hierarchical clustering analysis and non-parametric tests to characterize the epidemiological characteristics of TDD. Additionally, a dynamic transmission model was used to quantify the impact of shortening the TDD on the incidence rates of TB among the two groups. Results: There was an initial increase in the TDD, followed by a decrease. Longer TDDs were observed in the northeastern region of China. Farmers, middle and high school students, middle-aged, elderly individuals and males exhibited relatively longer TDDs. A significant reduction in the incidence rate of PTB was observed when the TDD was decreased by 50 %. However, only reducing the TDD among non-students could achieve the goal of ending TB (i.e., achieving a minimum reduction of 63.00 %). Conclusions: TDD remains a serious risk to public health, and non-students were shown to experience longer TDD. Shortening the TDD is crucial for reducing the incidence rates of TB, especially among non-students. It is essential to develop a highly sensitive and effective system for eliminating TB among non-students.

Expanding molecular diagnostic coverage for tuberculosis by combining computer-aided chest radiography and sputum specimen pooling: a modeling study from four high-burden countries.

Background: In 2022, fewer than half of persons with tuberculosis (TB) had access to molecular diagnostic tests for TB due to their high costs. Studies have found that the use of artificial intelligence (AI) software for chest X-ray (CXR) interpretation and sputum specimen pooling can each reduce the cost of testing. We modeled the combination of both strategies to estimate potential savings in consumables that could be used to expand access to molecular diagnostics. Methods: We obtained Xpert testing and positivity data segmented into deciles by AI probability scores for TB from the community- and healthcare facility-based active case finding conducted in Bangladesh, Nigeria, Viet Nam, and Zambia. AI scores in the model were based on CAD4TB version 7 (Zambia) and qXR (all other countries). We modeled four ordinal screening and testing approaches involving AI-aided CXR interpretation to indicate individual and pooled testing. Setting a false negative rate of 5%, for each approach we calculated additional and cumulative savings over the baseline of universal Xpert testing, as well as the theoretical expansion in diagnostic coverage. Results: In each country, the optimal screening and testing approach was to use AI to rule out testing in deciles with low AI scores and to guide pooled vs individual testing in persons with moderate and high AI scores, respectively. This approach yielded cumulative savings in Xpert tests over baseline ranging from 50.8% in Zambia to 57.5% in Nigeria and 61.5% in Bangladesh and Viet Nam. Using these savings, diagnostic coverage theoretically could be expanded by 34% to 160% across the different approaches and countries. Conclusions: Using AI software data generated during CXR interpretation to inform a differentiated pooled testing strategy may optimize TB diagnostic test use, and could extend molecular tests to more people who need them. The optimal AI thresholds and pooled testing strategy varied across countries, which suggests that bespoke screening and testing approaches may be needed for differing populations and settings. Supplementary Information: The online version contains supplementary material available at 10.1186/s44263-024-00081-2.

Using a Knowledge and Awareness Survey to Engage and Inform a Community-Based Tuberculosis Intervention among Nomads in Adamawa State, Nigeria.

BACKGROUND: Nomadic populations are frequently isolated and vulnerable to diseases including tuberculosis (TB) and human immunodeficiency virus (HIV) due to limited access to health-related information and services, poverty, and social exclusion. We designed and implemented community-driven and -based outreach for TB and HIV based on the results of a TB knowledge, attitude, and practices (KAP) survey in Adamawa, Nigeria. METHODS: We conducted a cross-sectional study on KAP among nomads using an adapted WHO survey. A TB and HIV community-level active case-finding intervention among nomadic populations was planned and delivered based on the KAP survey results. RESULTS: Among 81 respondents, 26 (32.1%) knew what caused TB. More than 60% reported no health facilities in their community. Radio and healthcare workers were primary sources of information on health. Using community input, we developed and broadcasted radio jingles to sensitize people to TB services. Outreach initiatives led to the verbal screening of 61,891 individuals and 306 were diagnosed with TB. Additionally, 4489 people underwent HIV testing, and 69 were HIV-positive, all of whom were linked to treatment. CONCLUSIONS: The results of KAP surveys can inform the design of evidence-based TB and HIV community-driven and -based case-finding interventions in rural Nigeria among nomadic populations.

In-home TB Testing Using GeneXpert Edge is Acceptable, Feasible, and Improves the Proportion of Symptomatic Household Contacts Tested for TB: A Proof-of-Concept Study.

Background: Household contact investigations are effective for finding tuberculosis (TB) cases but are hindered by low referral uptake for clinic-based evaluation and testing. We assessed the acceptability and feasibility of in-home testing of household contacts (HHC) using the GeneXpert Edge platform. Methods: We conducted a 2-arm, randomized study in Eastern Cape, South Africa. HHCs were verbally assessed using the World Health Organization-recommended 4-symptom screen. Households with ≥1 eligible symptomatic contact were randomized. Intervention households received in-home GeneXpert MTB/RIF molecular testing. GeneXpert-positive HHCs were referred for clinic-based treatment. Standard-of-care households were referred for clinic-based sputum collection and testing. We defined acceptability as agreeing to in-home testing and feasibility as generation of valid Xpert MTB/RIF results. The proportion and timeliness of test results received was compared between groups. Results: Eighty-four households were randomized (n = 42 per arm). Of 100 eligible HHCs identified, 98/100 (98%) provided consent. Of 51 HHCs allocated to the intervention arm, all accepted in-home testing; of those, 24/51 (47%) were sputum productive and 23/24 (96%) received their test results. Of 47 HCCs allocated to standard-of-care, 7 (15%) presented for clinic-based TB evaluation, 6/47 (13%) were tested, and 4/6 (67%) returned for their results. The median (interquartile range) number of days from screening to receiving test results was 0 (0) and 16.5 (11-15) in the intervention and standard-of-care arms, respectively. Conclusions: In-home testing for TB was acceptable, feasible, and increased HHCs with a molecular test result. In-home testing mitigates a major limitation of household contact investigations (dependency on clinic-based referral), revealing new strategies for enhancing early case detection.

Active Case Finding among Adults using an Individual's Vulnerability Score for Pulmonary Tuberculosis in a Rural Village of Goa: A Cross-sectional Study.

Background: "Detect-Treat-Prevent-Build" to achieve tuberculosis (TB)-free India is envisaged in the National Tuberculosis Elimination Program (NTEP). To be able to achieve this, it is important to address the fact that the most vulnerable and hard-to-reach groups need to undertake screening. The present review aimed to examine the vulnerability in connection with TB disparities faced by distinct sub-populations generally viewed as vulnerable and follow these for testing. Materials and Methods: The community-based cross-sectional study was conducted in the field practice area of sub-center Carambolim in a rural area of Goa for 3 months. The households were visited, and data collected via personal interviews were recorded on the questionnaire study tool. Based on the data, the participants' vulnerability mapping was done per the parameters identified. Results: Among 223 households, 528 persons were screened for vulnerability. The 47 highly vulnerable participants were advised sputum CBNAAT, of which 9 (19%) tested positive for pulmonary TB, while of the 86 moderately vulnerable participants, 4 (5%) tested positive for pulmonary TB. Among the 34 with symptoms suggestive of TB, 3 (9%) tested positive for pulmonary TB. Conclusions: The study detected 16 new TB patients from the population and found a higher incidence of pulmonary TB among the vulnerable group with no symptoms of Pulmonary TB. A further state-wide survey is recommended to diagnose such cases.

Population-wide active case finding as a strategy to end TB.

Tuberculosis (TB) is the leading infectious cause of morbidity and mortality globally. Despite available tools for preventing, finding, and treating TB, many people with TB remain undiagnosed. In high-incidence settings, TB transmission is ubiquitous within the community, affecting both high-risk groups and the general population. In fact, most people who develop TB come from the general population. To disrupt the chain of transmission that sustains the TB epidemic, we need to find and treat everyone with infectious TB as early as possible, including those with minimal symptoms or subclinical TB who are unlikely to present for care. Important elements of an effective active case-finding strategy include effective social mobilisation and community engagement, using sensitive screening tools that can be used at scale, and embracing population-wide screening in high-incidence ('hot spot') areas. We require a better description of feasible delivery models, 'real-life' impact and cost effectiveness to enable wider implementation.

A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India.

BACKGROUND: Tuberculosis (TB) remains a significant public health burden in India, with elimination targets set for 2025. Active case finding (ACF) is crucial for improving TB case detection rates, although conclusive evidence of its association with treatment outcomes is lacking. Our study aims to investigate the impact of ACF on successful TB treatment outcomes among pulmonary TB patients in Gujarat, India, and explore why ACF positively impacts these outcomes. METHODS: We conducted a retrospective cohort analysis in Gujarat, India, including 1,638 pulmonary TB cases identified through ACF and 80,957 cases through passive case finding (PCF) from January 2019 to December 2020. Generalized logistic mixed-model compared treatment outcomes between the ACF and PCF groups. Additionally, in-depth interviews were conducted with 11 TB program functionaries to explore their perceptions of ACF and its impact on TB treatment outcomes. RESULTS: Our analysis revealed that patients diagnosed through ACF exhibited 1.4 times higher odds of successful treatment outcomes compared to those identified through PCF. Program functionaries emphasized that ACF enhances case detection rates and enables early detection and prompt treatment initiation. This early intervention facilitates faster sputum conversion and helps reduce the infectious period, thereby improving treatment outcomes. Functionaries highlighted that ACF identifies TB cases that might otherwise be missed, ensuring timely and appropriate treatment. CONCLUSION: ACF significantly improves TB treatment outcomes in Gujarat, India. The mixed-methods analysis demonstrates a positive association between ACF and successful TB treatment, with early detection and prompt treatment initiation being key factors. Insights from TB program functionaries underscore the importance of ACF in ensuring timely diagnosis and treatment, which are critical for better treatment outcomes. Expanding ACF initiatives, especially among hard-to-reach populations, can further enhance TB control efforts. Future research should focus on optimizing ACF strategies and integrating additional interventions to sustain and improve TB treatment outcomes.

Integrating molecular and radiological screening tools during community-based active case-finding for tuberculosis and COVID-19 in southern Africa.

OBJECTIVES: To evaluate diagnostic yield and feasibility of integrating testing for TB and COVID-19 using molecular and radiological screening tools during community-based active case-finding (ACF). METHODS: Community-based participants with presumed TB and/or COVID-19 were recruited using a mobile clinic. Participants underwent simultaneous point-of-care (POC) testing for TB (sputum; Xpert Ultra) and COVID-19 (nasopharyngeal swabs; Xpert SARS-CoV-2). Sputum culture and SARS-CoV-2 RT-PCR served as reference standards. Participants underwent ultra-portable POC chest radiography with computer-aided detection (CAD). TB infectiousness was evaluated using smear microscopy, cough aerosol sampling studies (CASS), and chest radiographic cavity detection. Feasibility of POC testing was evaluated via user-appraisals. RESULTS: Six hundred and one participants were enrolled, with 144/601 (24.0%) reporting symptoms suggestive of TB and/or COVID-19. 16/144 (11.1%) participants tested positive for TB, while 10/144 (6.9%) tested positive for COVID-19 (2/144 [1.4%] had concurrent TB/COVID-19). Seven (7/16 [43.8%]) individuals with TB were probably infectious. Test-specific sensitivity and specificity (95% CI) were: Xpert Ultra 75.0% (42.8-94.5) and 96.9% (92.4-99.2); Xpert SARS-CoV-2 66.7% (22.3-95.7) and 97.1% (92.7-99.2). Area under the curve (AUC) for CAD4TB was 0.90 (0.82-0.97). User appraisals indicated POC Xpert to have 'good' user-friendliness. CONCLUSIONS: Integrating TB/COVID-19 screening during community-based ACF using POC molecular and radiological tools is feasible, has a high diagnostic yield, and can identity probably infectious persons.

For Tuberculosis, Not "To Screen or Not to Screen?" but "Who?" and "How?"

Active case finding leveraging new molecular diagnostics and chest X-rays with automated interpretation algorithms is increasingly being developed for high-risk populations to drive down tuberculosis incidence. We consider why such an approach did not deliver a decline in tuberculosis prevalence in Brazilian prison populations and what to consider next.

Tuberculosis Case Finding in Kulon Progo District, Yogyakarta, Indonesia: Passive versus Active Case Finding Using Mobile Chest X-ray.

Active-case finding (ACF) using chest X-ray is an essential method of finding and diagnosing Tuberculosis (TB) cases that may be missed in Indonesia's routine TB case finding. This study compares active and passive TB case-finding strategies. A retrospective study of TB case notification was conducted. Data between 1 January and 31 December 2021, was used. The population in this study were TB cases notified from Kulon Progo District health facilities, including those found through routine activities or active-case findings. A total of 249 TB cases were diagnosed in Kulon Progo in 2021, and 102 (41%) were bacteriologically confirmed. The TB patients' ages ranged from 0 to 85 years (median 52, IQR 31-61). The majority of cases were male (59%, 147/249) and mostly among people aged 15-59 (61.4%, 153/249). The proportion of clinical TB diagnoses among cases found from active-case findings was 74.7% (68/91) while the proportion among passive-case findings was 50% (79/158). Active-case finding contributed 91 (36.5%) TB cases to the total cases detected in Kulon Progo in 2021. The use of chest X-rays in active-case findings likely contributed to the detection of a higher proportion of clinical TB than in passive-case findings.

Active case finding of tuberculosis among nomads and semi-nomads in Puducherry.

Context: Tuberculosis (TB), is a global epidemic and communicable disease that accounts for increased global mortality and morbidity. India is also marching towards the elimination of tuberculosis by 2025 with this background we conducted this study. Aims: To identify the undiagnosed TB cases in nomadic and semi-nomadic populations of Puducherry. Settings and Design: A community-based cross-sectional study was done among nomads and semi-nomads in Puducherry for four months between May 2022 to September 2022 after getting the Institute's ethical committee approval. Methods and Material: After obtaining written consent/assent, a pretested semi structured questionnaire was used to record the data. The questionnaire consists of three parts that include, sociodemographic details and history specific to tuberculosis based on operational definitions such as presumptive TB and physical examination. Those participants fulfilling the criteria for presumptive TB was provided a Falcon tube for spot sample. The participants were explained the procedure to collect the sputum and its quality was verified by the principal investigator before sending it to the laboratory. Statistical analysis used: Data was analysed with Statistical Package for Social Science (SPSS Inc, Chicago, Illinois, USA) software version 16.0 and Microsoft Excel 2016. Frequencies and percentages were estimated for categorical data. Results: Our study showed 6.25% was the proportion of presumptive TB cases in our study population. In the presumptive TB cases 60% belonged to age >45yrs 80% belonged to the male gender and all of them belonged to lower socioeconomic status. The macro-environment findings of those presumptive TB cases were 80% belonged Kutcha houses, with poor ventilation and overcrowding present. Their co-morbidity status indicates 60% were diabetics and 20% were hypertensive. Their predominant findings were 80% reported Cough and 20% fever, significant weight loss. No contact history of TB was found. When these presumptive TB cases underwent microbiological examination, none were sputum positive. Conclusions: This study showed ACF helped to identify presumptive TB in an effective way and needs large-scale screening to identify sputum-positive cases.

Active Case Finding for Tuberculosis in Migrants: a Systematic Review.

Background: Active case finding (ACF) is an alternative strategy to accelerate the identification of TB cases among the migrant population. Objective: This study aimed to synthesize the evidence for the effectiveness of ACF TB in migrants. Methods: This study uses the PRISMA model as a method of searching for journal articles in the databases of Google Scholar, ProQuest, EBSCO, ScienceDirect, Elsevier, and PubMed, as well as other sources such as textbooks and reports from 2017 to 2021 with the keywords "tuberculosis" AND "active case finding" AND "migrant". The search revealed 371 articles, of which 26 met the criteria for further discussion. Results: Most studies show that the TB incidence among migrants is higher than in the local population. Factors leading to increased cases include lack of knowledge about the symptoms, high mobilization, social isolation, economic problems, and medication adherence that impact an advanced stage. Furthermore, it is also influenced by the low quality of health services, including accessibility, health facilities, health workers, and information. Therefore, Active Case Finding (ACF) is more effective in identifying cases of TB in the risk groups. This was conducted on migrants with increased notifications followed up with treatment. Conclusion: ACF is effective approach in screening and diagnosing TB in the migrant group.

Diagnostic Accuracy of Computer-Aided Detection During Active Case Finding for Pulmonary Tuberculosis in Africa: A Systematic Review and Meta-analysis.

Background: Computer-aided detection (CAD) may be a useful screening tool for tuberculosis (TB). However, there are limited data about its utility in active case finding (ACF) in a community-based setting, and particularly in an HIV-endemic setting where performance may be compromised. Methods: We performed a systematic review and evaluated articles published between January 2012 and February 2023 that included CAD as a screening tool to detect pulmonary TB against a microbiological reference standard (sputum culture and/or nucleic acid amplification test [NAAT]). We collected and summarized data on study characteristics and diagnostic accuracy measures. Two reviewers independently extracted data and assessed methodological quality against Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines were followed. Results: Of 1748 articles reviewed, 5 met with the eligibility criteria and were included in this review. A meta-analysis revealed pooled sensitivity of 0.87 (95% CI, 0.78-0.96) and specificity of 0.74 (95% CI, 0.55-0.93), just below the World Health Organization (WHO)-recommended target product profile (TPP) for a screening test (sensitivity ≥0.90 and specificity ≥0.70). We found a high risk of bias and applicability concerns across all studies. Subgroup analyses, including the impact of HIV and previous TB, were not possible due to the nature of the reporting within the included studies. Conclusions: This review provides evidence, specifically in the context of ACF, for CAD as a potentially useful and cost-effective screening tool for TB in a resource-poor HIV-endemic African setting. However, given methodological concerns, caution is required with regards to applicability and generalizability.

Pooled sputum testing by Xpert® MTB/RIF Ultra for active tuberculosis case finding among high-risk groups in a low-incidence area: a prospective study.

BACKGROUND: Early detection and treatment of tuberculosis (TB) are of great importance to stop its spread. However, optimising the active case findingstrategy is critical to improving its feasibility in regions where TB is epidemic. METHOD: The different pooled ratios between TB-positive and TB-negative sputum specimens were evaluated and a pooling ratio of 5:1 was used for the active case finding screening by Xpert MTB/RIF Ultra among high-risk groups in Beijing. RESULTS: The sensitivity of pooling ratio at 5:1 was 97.5% (39/40). Between October 2022 and March 2023, among 17,681 participants, 1729 metthe active case finding criteria and were screened by 350 5:1 sputum pools by Xpert MTB/RIF Ultra. Four pools (1.1%) tested positive and were further confirmed as definite active TB cases. In our study population with high TB incidence (231/100,000), the cost for detection of individual patients was reduced by 77.4% at a 5:1 pooling ratio. CONCLUSIONS: pooled sputum testing at a suitable ratio using Xpert MTB/RIF Ultra provides a rapid, efficient, and cost-effective method for active TB case finding among high-risk groups in a low-incidence area.

TB-free Ebeye: Results from integrated TB and noncommunicable disease case finding in Ebeye, Marshall Islands.

Background: Tuberculosis (TB) incidence rates in the Republic of the Marshall Islands are among the highest in the world, 480/100,000 in 2017. In response, the Health Ministry completed islandwide screening in Ebeye Island in 2017. Methods: Participants were interviewed to obtain TB history, exposures, and symptoms. TB assessment included chest radiography with sputum collection for GeneXpert® MTB-RIF if indicated. TB diagnosis was made by consensus of visiting TB experts. Participants were also screened for Hansen's disease (HD) and diabetes mellitus (DM). For persons aged ≥21 years, blood pressure, cholesterol, and blood glucose were assessed. Results: A total of 5,166 persons (90.0 % of target population) completed screening leading to the identification of 39 new cases of TB (755/100,000) and 14 persons with HD (270/100,000). DM was detected in 1,096 persons (27 %), including in 351 persons not previously diagnosed. The rate of hypertension was 61 % and of hypercholesterolemia was 15 %. New or prevalent TB diagnosis was associated with newly diagnosed or history of DM (aOR 4.68, 2.15-10.20). Conclusions: In Ebeye, an integrated TB screening campaign found TB, HD, DM, and hypertension. TB and DM were strongly associated.