1
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Bates G, Hill PC, Koroituku I, Wilson D, Reddy M, Kama M. A tuberculosis elimination-focused geospatial approach to optimising access to diagnostic GeneXpert machines in Fiji. Trop Med Int Health 2024. [PMID: 38837811 DOI: 10.1111/tmi.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
OBJECTIVES Fiji could be the first country to eliminate tuberculosis. To inform this strategy, we aimed to identify how many GeneXpert® machines are required to enable over 90% of Fijians to be within one-hour easy access. METHODS We used Geographic Information System (Quantum GIS; QGIS), OpenStreetMap and population data (Kontur) to map possible facilities in relation to QGIS generated 60-min drive-time isochrones, with correction for missing road data. For outer islands, we calculated a distance to nearest hub operation. RESULTS The solution comprised 24 GeneXpert® machines, allocating 7 GeneXpert® to Viti Levu, 6 GeneXpert® to Vanua Levu and 11 to other islands. This resulted in 827,810 people, 93.6% of Fiji's population, being within 1 h of a machine. Twenty-one thousand four hundred seventy-nine people on outer islands were an average of 43 km by water from the nearest facility. CONCLUSIONS We conclude that over 90% of Fijians could be within an hour of a GeneXpert® machine with placement of 24 machines.
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Affiliation(s)
- George Bates
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
- Communicable Diseases Research Centre, Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji
| | - Isireli Koroituku
- Communicable Diseases Research Centre, Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji
| | - Donald Wilson
- Communicable Diseases Research Centre, Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji
| | - Mun Reddy
- National Tuberculosis Control Program, Ministry of Health, Suva, Fiji
| | - Mike Kama
- National Tuberculosis Control Program, Ministry of Health, Suva, Fiji
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2
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Nguyen TA, Jing Teo AK, Zhao Y, Quelapio M, Hill J, Morishita F, Marais BJ, Marks GB. Population-wide active case finding as a strategy to end TB. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101047. [PMID: 38827931 PMCID: PMC11143452 DOI: 10.1016/j.lanwpc.2024.101047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 06/05/2024]
Abstract
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.
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Affiliation(s)
- Thu-Anh Nguyen
- The University of Sydney Vietnam Institute, Ho Chi Minh City, Vietnam
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
| | - Alvin Kuo Jing Teo
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yanlin Zhao
- Chinese Centre for Disease Control and Prevention, Beijing, China
| | | | - Jeremy Hill
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
| | - Fukushi Morishita
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Ben J. Marais
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
| | - Guy B. Marks
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Woolcock Institute of Medical Research, Sydney, Australia
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3
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Teo AKJ, Morishita F, Islam T, Viney K, Ong CW, Kato S, Kim H, Liu Y, Oh KH, Yoshiyama T, Ohkado A, Rahevar K, Kawatsu L, Yanagawa M, Prem K, Yi S, Tran HTG, Marais BJ. Tuberculosis in older adults: challenges and best practices in the Western Pacific Region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100770. [PMID: 37547037 PMCID: PMC10398605 DOI: 10.1016/j.lanwpc.2023.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/18/2023] [Accepted: 04/02/2023] [Indexed: 08/08/2023]
Abstract
The Western Pacific has one of the fastest-growing older adult populations globally, and tuberculosis (TB) remains one of the foremost infectious causes of disease and death in the region. Older adults are at higher risk of TB due to immunosenescence, comorbidities, and increased institutionalisation. Atypical symptoms and reduced access to health services may delay care-seeking and TB diagnosis, while co-morbidity and increased risk of adverse drug reactions complicate TB treatment. Post-TB sequelae and socioeconomic challenges may decrease the quality of life after TB treatment completion. Despite their high disease burden and special challenges, there is a lack of regionally coordinated policies and guidelines to manage TB among older adults. Routine TB screening at aged-care facilities, age-friendly infrastructure and services, awareness of atypical TB features, integration of TB and non-communicable diseases services, and person-centred approaches to treatment support could improve TB management among older adults. Addressing these challenges and adopting the best practices identified should inform policy formulation and implementation. Funding This project was funded by 1) the World Health Organization Regional Office for the Western Pacific, with financial contributions from the Government of the Republic of Korea through the Korean Disease Control and Prevention Agency and the Government of Japan through the Ministry of Health, Labour and Welfare, and 2) NUS Start-up Grant. The funders had no role in the paper design, collection, analysis, and interpretation of data and in writing of the paper.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
| | - Fukushi Morishita
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Tauhid Islam
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland
| | - Catherine W.M. Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Seiya Kato
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - HeeJin Kim
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Kyung Hyun Oh
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Takashi Yoshiyama
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Akihiro Ohkado
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kalpeshsinh Rahevar
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Lisa Kawatsu
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Manami Yanagawa
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA, USA
| | - Huong Thi Giang Tran
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Ben J. Marais
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
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4
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Teo AKJ, Morishita F, Prem K, Eng S, An Y, Huot CY, Khun KE, Tieng S, Deng S, Tuot S, Yi S. Where are the missing people affected by tuberculosis? A programme review of patient-pathway and cascade of care to optimise tuberculosis case-finding, treatment and prevention in Cambodia. BMJ Glob Health 2023; 8:bmjgh-2022-010994. [PMID: 36921989 PMCID: PMC10030488 DOI: 10.1136/bmjgh-2022-010994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/08/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Cambodia has achieved great success in tuberculosis (TB) control in the past decade. Nevertheless, people with TB are missed by the health systems at different stages of the care pathway. This programme review corroborated the care-seeking behaviours of people with TB and TB services availability and estimated the number of people completing each step of the TB disease and TB preventive treatment (TPT) care cascade. METHODS Patient pathways and the care cascades for TB disease and TPT were constructed using data from the latest national TB prevalence survey, routine surveillance and programme, the global TB database and published studies. We also randomly selected TB survivors in the 2019 cohort to assess recurrence-free survival 1-year post-treatment. TPT care cascade was constructed for people living with HIV (PLHIV) and household contacts (children <5 years and all ages) of persons with bacteriologically-confirmed TB in 2019 and 2020. RESULTS Nationally, 54% of those who exhibited TB symptoms sought initial care in the private sector. Overall, 93% and 58% of people with presumptive TB did not access a facility with TB diagnostic and treatment services, respectively, at the first point of care-seeking. Approximately 56% (95% CI 52% to 57%) of the 47 000 (95% CI 31 000 to 68 000) estimated TB cases in 2019 achieved recurrence-free survival. Among the estimated PLHIV in Cambodia, <30% completed TPT. Among children <5 years, 53% (95% CI 29% to 65%) (2019) and 67% (95% CI 36% to 80%) (2020) of those eligible for TPT completed the regimen successfully. In 2019 and 2020, 23% (95% CI 22% to 25%) and 54% (95% CI 50% to 58%) of the estimated household contacts (all ages) eligible for TPT completed the regimen successfully. CONCLUSION There are significant gaps in care-seeking, coverage and access to TB services and TPT in Cambodia. Action plans to improve TB response have been co-developed with local stakeholders to address the gaps throughout the care cascades.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
| | - Fukushi Morishita
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sothearith Eng
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yom An
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Sustaining Technical and Analytical Resources (STAR), Public Health Institute (PHI), Phnom Penh, Cambodia
| | - Chan Yuda Huot
- National Center for Tuberculosis and Leprosy Control (CENAT), Phnom Penh, Cambodia
| | - Kim Eam Khun
- National Center for Tuberculosis and Leprosy Control (CENAT), Phnom Penh, Cambodia
| | - Sivanna Tieng
- National Center for Tuberculosis and Leprosy Control (CENAT), Phnom Penh, Cambodia
| | - Serongkea Deng
- World Health Organization Cambodia Representative Office, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Faculty of Social Science and Humanities, Royal University of Phnom Penh, Phnom Penh, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, California, USA
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5
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Puma D, Yuen CM, Millones AK, Brooks MB, Jimenez J, Calderon RI, Lecca L, Becerra MC, Keshavjee S. Sensitivity of Various Case Detection Algorithms for Community-based Tuberculosis Screening. Clin Infect Dis 2023; 76:e987-e989. [PMID: 35723266 DOI: 10.1093/cid/ciac492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022] Open
Abstract
Using data from 388 people diagnosed with tuberculosis through a community-based screening program in Lima, Peru, we estimated that cough screening followed by sputum smear microscopy would have detected only 23% of cases found using an algorithm of radiographic screening followed by rapid nucleic acid amplification testing and clinical evaluation.
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Affiliation(s)
| | - Courtney M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Center for Global Health Delivery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Meredith B Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Center for Global Health Delivery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Roger I Calderon
- Socios En Salud Sucursal Perú, Lima, Peru.,Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonid Lecca
- Socios En Salud Sucursal Perú, Lima, Peru.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Mercedes C Becerra
- Socios En Salud Sucursal Perú, Lima, Peru.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Center for Global Health Delivery, Harvard Medical School, Boston, Massachusetts, USA
| | - Salmaan Keshavjee
- Socios En Salud Sucursal Perú, Lima, Peru.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Center for Global Health Delivery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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6
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Ma J, Vongpradith A, Ledesma JR, Novotney A, Yi S, Lim K, Hay SI, Murray CJL, Kyu HH. Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019. BMC Infect Dis 2022; 22:904. [PMID: 36463098 PMCID: PMC9719136 DOI: 10.1186/s12879-022-07891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cambodia was recently removed from the World Health Organization's (WHO's) top 30 high tuberculosis (TB) burden countries. However, Cambodia's TB burden remains substantial, and the country is on the WHO's new global TB watchlist. We aimed to examine the levels and trends in the fatal and non-fatal TB burden in Cambodia from 1990 to 2019, assessing progress towards the WHO End TB interim milestones, which aim to reduce TB incidence rate by 20% and TB deaths by 35% from 2015 to 2020. METHODS We leveraged the Global Burden of Disease 2019 (GBD 2019) analytical framework to compute age- and sex-specific TB mortality and incidence by HIV status in Cambodia. We enumerated TB mortality utilizing a Bayesian hierarchical Cause of Death Ensemble modeling platform. We analyzed all available data sources, including prevalence surveys, population-based tuberculin surveys, and TB cause-specific mortality, to produce internally consistent estimates of incidence and mortality using a compartmental meta-regression tool (DisMod-MR 2.1). We further estimated the fraction of tuberculosis mortality among individuals without HIV coinfection attributable to the independent effects of alcohol use, smoking, and diabetes. RESULTS In 2019, there were 6500 (95% uncertainty interval 4830-8680) deaths due to all-form TB and 50.0 (43.8-57.8) thousand all-form TB incident cases in Cambodia. The corresponding age-standardized rates were 53.3 (39.9-69.4) per 100,000 population for mortality and 330.5 (289.0-378.6) per 100,000 population for incidence. From 2015 to 2019, the number of all-form TB deaths decreased by 11.8% (2.3-21.1), while the age-standardized all-form TB incidence rate decreased by 11.1% (6.3-15.6). Among individuals without HIV coinfection in 2019, alcohol use accounted for 28.1% (18.2-37.9) of TB deaths, smoking accounted for 27.0% (20.2-33.3), and diabetes accounted for 12.5% (7.1-19.0). Removing the combined effects of these risk factors would reduce all-form TB deaths by 54.2% (44.2-62.2). DISCUSSION Despite significant progress in reducing TB morbidity and mortality since 1990, Cambodia is not on track to achieve the 2020 WHO End TB interim milestones. Existing programs in Cambodia can benefit from liaising with risk factor control initiatives to accelerate progress toward eliminating TB in Cambodia.
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Affiliation(s)
- Jianing Ma
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA
| | - Avina Vongpradith
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA
| | - Jorge R. Ledesma
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA
| | - Amanda Novotney
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA
| | - Siyan Yi
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.513124.00000 0005 0265 4996KHANA Center for Population Health Research, Phnom Penh, Cambodia ,grid.265117.60000 0004 0623 6962Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA USA
| | - Kruy Lim
- grid.452809.20000 0004 0396 8383Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia
| | - Simon I. Hay
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Health Metrics Sciences, University of Washington, Seattle, WA USA
| | - Christopher J. L. Murray
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Health Metrics Sciences, University of Washington, Seattle, WA USA
| | - Hmwe H. Kyu
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Health Metrics Sciences, University of Washington, Seattle, WA USA
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7
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Independent evaluation of 12 artificial intelligence solutions for the detection of tuberculosis. Sci Rep 2021; 11:23895. [PMID: 34903808 PMCID: PMC8668935 DOI: 10.1038/s41598-021-03265-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
There have been few independent evaluations of computer-aided detection (CAD) software for tuberculosis (TB) screening, despite the rapidly expanding array of available CAD solutions. We developed a test library of chest X-ray (CXR) images which was blindly re-read by two TB clinicians with different levels of experience and then processed by 12 CAD software solutions. Using Xpert MTB/RIF results as the reference standard, we compared the performance characteristics of each CAD software against both an Expert and Intermediate Reader, using cut-off thresholds which were selected to match the sensitivity of each human reader. Six CAD systems performed on par with the Expert Reader (Qure.ai, DeepTek, Delft Imaging, JF Healthcare, OXIPIT, and Lunit) and one additional software (Infervision) performed on par with the Intermediate Reader only. Qure.ai, Delft Imaging and Lunit were the only software to perform significantly better than the Intermediate Reader. The majority of these CAD software showed significantly lower performance among participants with a past history of TB. The radiography equipment used to capture the CXR image was also shown to affect performance for some CAD software. TB program implementers now have a wide selection of quality CAD software solutions to utilize in their CXR screening initiatives.
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8
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Teo AKJ, Prem K, Wang Y, Pande T, Smelyanskaya M, Gerstel L, Chry M, Tuot S, Yi S. Economic Evaluation of Community Tuberculosis Active Case-Finding Approaches in Cambodia: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312690. [PMID: 34886416 PMCID: PMC8656683 DOI: 10.3390/ijerph182312690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
| | - Tripti Pande
- McGill International TB Centre, Montreal, QC H4A 3S5, Canada;
| | | | - Lisanne Gerstel
- KIT Royal Tropical Institute, 1092 AD Amsterdam, The Netherlands;
| | - Monyrath Chry
- Cambodia Anti-Tuberculosis Association, Phnom Penh 12303, Cambodia;
| | - Sovannary Tuot
- KHANA Centre for Population Health Research, Phnom Penh 12301, Cambodia;
- Faculty of Social Sciences and Humanity, Royal University of Phnom Penh, Phnom Penh 12150, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
- KHANA Centre for Population Health Research, Phnom Penh 12301, Cambodia;
- Center for Global Health Research, Touro University California, Vallejo, CA 94592, USA
- Correspondence:
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9
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Yuen CM, Puma D, Millones AK, Galea JT, Tzelios C, Calderon RI, Brooks MB, Jimenez J, Contreras C, Nichols TC, Nicholson T, Lecca L, Becerra MC, Keshavjee S. Identifying barriers and facilitators to implementation of community-based tuberculosis active case finding with mobile X-ray units in Lima, Peru: a RE-AIM evaluation. BMJ Open 2021; 11:e050314. [PMID: 34234000 PMCID: PMC8264873 DOI: 10.1136/bmjopen-2021-050314] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Identify barriers and facilitators to integrating community tuberculosis screening with mobile X-ray units into a health system. METHODS Reach, effectiveness, adoption, implementation and maintenance evaluation. SETTING 3-district region of Lima, Peru. PARTICIPANTS 63 899 people attended the mobile units from 7 February 2019 to 6 February 2020. INTERVENTIONS Participants were screened by chest radiography, which was scored for abnormality by computer-aided detection. People with abnormal X-rays were evaluated clinically and by GeneXpert MTB/RIF (Xpert) sputum testing. People diagnosed with tuberculosis at the mobile unit were accompanied to health facilities for treatment initiation. PRIMARY AND SECONDARY OUTCOME MEASURES Reach was defined as the percentage of the population of the three-district region that attended the mobile units. Effectiveness was defined as the change in tuberculosis case notifications over a historical baseline. Key implementation fidelity indicators were the percentages of people who had chest radiography performed, were evaluated clinically, had sputum samples collected, had valid Xpert results and initiated treatment. RESULTS The intervention reached 6% of the target population and was associated with an 11% (95% CI 6 to 16) increase in quarterly case notifications, adjusting for the increasing trend in notifications over the previous 3 years. Implementation indicators for screening, sputum collection and Xpert testing procedures all exceeded 85%. Only 82% of people diagnosed with tuberculosis at the mobile units received treatment; people with negative or trace Xpert results were less likely to receive treatment. Suboptimal treatment initiation was driven by health facility doctors' lack of familiarity with Xpert and lack of confidence in diagnoses made at the mobile unit. CONCLUSION Mobile X-ray units were a feasible and effective strategy to extend tuberculosis diagnostic services into communities and improve early case detection. Effective deployment however requires advance coordination among stakeholders and targeted provider training to ensure that people diagnosed with tuberculosis by new modalities receive prompt treatment.
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Affiliation(s)
- Courtney M Yuen
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Jerome T Galea
- School of Social Work, University of South Florida, Tampa, Florida, USA
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Roger I Calderon
- Socios En Salud Sucursal Peru, Lima, Peru
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Meredith B Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Tim C Nichols
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Nicholson
- Center for International Development, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
- Advance Access & Delivery, Durham, North Carolina, USA
| | | | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Health Delivery, Harvard Medical School, Boston, Massachusetts, USA
| | - Salmaan Keshavjee
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Global Health Delivery, Harvard Medical School, Boston, Massachusetts, USA
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10
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Zokufa N, Lebelo K, Hacking D, Tabo L, Runeyi P, Malabi N, Sibanda SB, Cassidy T, Makanda G, Norman B, Khuzani S, Furin J, Jonker C, Nkasana B, Scott V, Pfaff C. Community-based TB testing as an essential part of TB recovery plans in the COVID-19 era. Int J Tuberc Lung Dis 2021; 25:406-408. [PMID: 33977911 PMCID: PMC8091909 DOI: 10.5588/ijtld.21.0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- N Zokufa
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - K Lebelo
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - D Hacking
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - L Tabo
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - P Runeyi
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - N Malabi
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - S B Sibanda
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - T Cassidy
- Médecins Sans Frontières, Khayelitsha, South Africa, Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - G Makanda
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - B Norman
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - S Khuzani
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - C Jonker
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - B Nkasana
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - V Scott
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - C Pfaff
- Médecins Sans Frontières, Khayelitsha, South Africa
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11
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Nguyen LH, Codlin AJ, Vo LNQ, Dao T, Tran D, Forse RJ, Vu TN, Le GT, Luu T, Do GC, Truong VV, Minh HDT, Nguyen HH, Creswell J, Caws M, Nguyen HB, Nguyen NV. An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam. Trop Med Infect Dis 2020; 5:tropicalmed5040185. [PMID: 33321696 PMCID: PMC7768495 DOI: 10.3390/tropicalmed5040185] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023] Open
Abstract
Across Asia, a large proportion of people with tuberculosis (TB) do not report symptoms, have mild symptoms or only experience symptoms for a short duration. These individuals may not seek care at health facilities or may be missed by symptom screening, resulting in sustained TB transmission in the community. We evaluated the yields of TB from 114 days of community-based, mobile chest X-ray (CXR) screening. The yields at each step of the TB screening cascade were tabulated and we compared cohorts of participants who reported having a prolonged cough and those reporting no cough or one of short duration. We estimated the marginal yields of TB using different diagnostic algorithms and calculated the relative diagnostic costs and cost per case for each algorithm. A total of 34,529 participants were screened by CXR, detecting 256 people with Xpert-positive TB. Only 50% of those diagnosed with TB were detected among participants reporting a prolonged cough. The study’s screening algorithm detected almost 4 times as much TB as the National TB Program’s standard diagnostic algorithm. Community-based, mobile chest X-ray screening can be a high yielding strategy which is able to identify people with TB who would likely otherwise have been missed by existing health services.
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Affiliation(s)
- Lan Huu Nguyen
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700 000, Vietnam; (L.H.N.); (G.C.D.); (V.V.T.); (H.D.T.M.)
| | - Andrew J. Codlin
- Friends for International TB Relief, Ho Chi Minh City 700 000, Vietnam; (L.N.Q.V.); (D.T.); (R.J.F.)
- Correspondence: ; Tel.: +84-352512847
| | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Ho Chi Minh City 700 000, Vietnam; (L.N.Q.V.); (D.T.); (R.J.F.)
- Interactive Research and Development, Singapore 238884, Singapore
| | - Thang Dao
- IRD VN, Ho Chi Minh City 700 000, Vietnam;
| | - Duc Tran
- Friends for International TB Relief, Ho Chi Minh City 700 000, Vietnam; (L.N.Q.V.); (D.T.); (R.J.F.)
| | - Rachel J. Forse
- Friends for International TB Relief, Ho Chi Minh City 700 000, Vietnam; (L.N.Q.V.); (D.T.); (R.J.F.)
| | - Thanh Nguyen Vu
- Ho Chi Minh City Public Health Association, Ho Chi Minh City 700 000, Vietnam; (T.N.V.); (G.T.L.)
| | - Giang Truong Le
- Ho Chi Minh City Public Health Association, Ho Chi Minh City 700 000, Vietnam; (T.N.V.); (G.T.L.)
| | - Tuan Luu
- Clinton Health Access Initiative Vietnam, Ha Noi 100 000, Vietnam;
| | - Giang Chau Do
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700 000, Vietnam; (L.H.N.); (G.C.D.); (V.V.T.); (H.D.T.M.)
| | - Vinh Van Truong
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700 000, Vietnam; (L.H.N.); (G.C.D.); (V.V.T.); (H.D.T.M.)
| | - Ha Dang Thi Minh
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700 000, Vietnam; (L.H.N.); (G.C.D.); (V.V.T.); (H.D.T.M.)
| | - Hung Huu Nguyen
- Ho Chi Minh City Department of Health, Ho Chi Minh City 700 000, Vietnam;
| | | | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
- Birat Nepal Medical Trust Nepal, Kathmandu 44600, Nepal
| | - Hoa Binh Nguyen
- Viet Nam National Lung Hospital, Ha Noi 100 000, Vietnam; (H.B.N.); (N.V.N.)
| | - Nhung Viet Nguyen
- Viet Nam National Lung Hospital, Ha Noi 100 000, Vietnam; (H.B.N.); (N.V.N.)
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