Performance of algorithms for tuberculosis active case finding in underserved high-prevalence settings in Cambodia: a cross-sectional study

Autor: Lisanne Gerstel, Sopheak Thai, Natalie Lorent, Kimcheng Choun, Tom Decroo, Tan Eang Mao, Andrew J. Codlin, Jacob Creswell, Lutgarde Lynen
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Outreach
Cross-sectional study
chest x-ray
Smear microscopy
0302 clinical medicine
Prevalence
030212 general & internal medicine
Public
Environmental & Occupational Health
High prevalence
030503 health policy & services
Health Policy
lcsh:Public aspects of medicine
sputum smear microscopy
Middle Aged
xpert mtb/rif
clinical diagnosis
Original Article
Female
Cambodia
0305 other medical science
Life Sciences & Biomedicine
Algorithms
Adult
medicine.medical_specialty
Tuberculosis
Adolescent
STRATEGIES
Xpert MTB
Young Adult
03 medical and health sciences
medicine
Humans
outreach
Tuberculosis
Pulmonary
Science & Technology
RIF
business.industry
Sputum
Public Health
Environmental and Occupational Health
lcsh:RA1-1270
Mycobacterium tuberculosis
medicine.disease
chest X-ray
Cross-Sectional Studies
Logistic Models
Family medicine
Clinical diagnosis
Case finding
business
Zdroj: Global Health Action, Vol 12, Iss 1 (2019)
Global Health Action
ISSN: 1654-9880
Popis: Background: Most studies evaluate active case findings (ACF) for bacteriologically confirmed TB. Adapted diagnostic approaches are needed to identify cases with lower bacillary loads. Objectives: To assess the likelihood of diagnosing all forms of TB, including clinically diagnosed pulmonary and extra-pulmonary TB, using different ACF algorithms in Cambodia. Methods: Clients were stratified into 'high-risk' (presumptive TB plus TB contact, or history of TB, or presumptive HIV infection; n = 12,337) and 'moderate-risk' groups (presumptive TB; n = 28,804). Sputum samples were examined by sputum smear microscopy (SSM) or Xpert MTB/RIF (Xpert). Initially, chest X-ray using a mobile radiography unit was a follow-up test after a negative sputum examination [algorithms A (Xpert/X-ray) and B (SSM/X-ray)]. Subsequently, all clients received an X-ray [algorithms C (X-ray+Xpert) and D (Xray+SSM/Xpert)]. X-rays were interpreted on the spot. Results: Between 25 August 2014 and 31 March 2016, 2217 (5.4%) cases with all forms of TB cases were diagnosed among 41,141 adults. The majority of TB cases (1488; 67.1%) were diagnosed using X-ray. When X-rays were taken and interpreted the same day the sputum was collected, same-day diagnosis more than doubled. Overall, the number needed to test (NNT) to diagnose one case was 18.6 (95%CI:17.9-19.2). In the high-risk group the NNT was lower [algorithm D: NNT = 17.3(15.9-18.9)] compared with the 'moderate-risk group' [algorithm D: NNT = 20.8(19.6-22.2)]. In the high-risk group the NNT was lower when using Xpert as an initial test [algorithm A: NNT = 12.2(10.8-13.9) or algorithm C: NNT = 11.2(9.6-13.0)] compared with Xpert as a follow-up test [algorithm D: NNT = 17.3(15.9-18.9)]. Conclusion: To diagnose all TB forms, X-ray should be part of the diagnostic algorithm. The combination of X-ray and Xpert testing for high-risk clients was the most effective ACF approach in this setting. ispartof: GLOBAL HEALTH ACTION vol:12 issue:1 ispartof: location:United States status: published
Databáze: OpenAIRE
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