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Microbiological methods of TB diagnosis. NAAT nucleic acid amplification test, TB tuberculosis. Includes all participants diagnosed on smear and/or NAAT and/or culture
Source publication
Background
People with subclinical tuberculosis (TB) have microbiological evidence of disease caused by Mycobacterium tuberculosis , but either do not have or do not report TB symptoms. The relationship between human immunodeficiency virus (HIV) and subclinical TB is not yet well understood. We estimated the prevalence of subclinical pulmonary TB i...
Context in source publication
Context 1
... (Fig. 2). For participants with a microbiological TB result, 95.3% (1979/2077) had a NAAT result, 73.4% (1525/2077) had a smear result, and 76.4% (1586/2077) had a culture result. For participants classified as having subclinical and symptomatic TB, 85.4% (41/48) and 65.0% (13/20), respectively, were diagnosed on a single microbiological test (Fig. 3). Table 1 provides characteristics of the 2077 household contact participants with a microbiological TB result, of whom 1190 (57.3%) were residents in Mangaung and 887 (42.7%) in Capricorn. The median age of household contacts with a sputum result was 24 years (IQR 13-46), and 64.9% were female. 18.2% were living with HIV, of whom 66.0% ...
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Citations
... However, data on this are still scarce. In this collection, Carter et al. estimated the prevalence of subclinical pulmonary TB in household contacts of index TB patients in two South African provinces, and how this differed by HIV status [7]. The authors found that almost 71% of pulmonary TB diagnosed in household contacts in this setting was subclinical. ...
... Finally, we only tested HHCs that reported TB-related symptoms. Given the estimated large pool of subclinical TB in South Africa, 41 while techniques such as sputum induction can facilitate the production of quality spot sputum, future studies may benefit from collecting oral swab specimens in conjunction with sputum. 42 ...
Background
Household contact investigations (HCI) are effective for finding tuberculosis (TB) cases but 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 two-arm, randomized study in Eastern Cape, South Africa. HHCs were verbally assessed using the WHO-recommended four-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 (IQR) number of days from screening to receiving-of-test-results was 0 (0) and 16.5 (11-15) in 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 HCIs (dependency on clinic-based referral), revealing new strategies for enhancing early case detection.
