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Shapiro AN, Scott L, Moultrie H, Jacobson KR, Bor J, Fofana AM, Dor G, Ndjeka NO, da Silva P, Mlisana K, Jenkins HE, Stevens WS. Tuberculosis testing patterns in South Africa to identify groups that would benefit from increased investigation. Sci Rep 2023; 13:20875. [PMID: 38012266 PMCID: PMC10682361 DOI: 10.1038/s41598-023-47148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
The National Health Laboratory Service (NHLS) collects all public health laboratory test results in South Africa, providing a cohort from which to identify groups, by age, sex, HIV, and viral suppression status, that would benefit from increased tuberculosis (TB) testing. Using NHLS data (2012-2016), we assessed levels and trends over time in TB diagnostic tests performed (count and per capita) and TB test positivity. Estimates were stratified by HIV status, viral suppression, age, sex, and province. We used logistic regression to estimate the odds of testing positive for TB by viral suppression status. Nineteen million TB diagnostic tests were conducted during period 2012-2016. Testing per capita was lower among PLHIV with viral suppression than those with unsuppressed HIV (0.08 vs 0.32) but lowest among people without HIV (0.03). Test positivity was highest among young adults (aged 15-35 years), males of all age groups, and people with unsuppressed HIV. Test positivity was higher for males without laboratory evidence of HIV than those with HIV viral suppression, despite similar individual odds of TB. Our results are an important national baseline characterizing who received TB testing in South Africa. People without evidence of HIV, young adults, and males would benefit from increased TB screening given their lower testing rates and higher test positivity. These high-test positivity groups can be used to guide future expansions of TB screening.
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Affiliation(s)
- Anne N Shapiro
- Department of Biostatistics, Boston University School of Public Health, Boston, USA.
- Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lesley Scott
- Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Harry Moultrie
- Centre for Tuberculosis, A division of the National Health Laboratory Services, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Karen R Jacobson
- Division of Infectious Diseases, Boston Medical Center, Boston, USA
| | - Jacob Bor
- Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Abdou M Fofana
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
- Questrom School of Business, Institute for Health System Innovation & Policy, Boston University, Boston, USA
| | - Graeme Dor
- Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Pedro da Silva
- National Health Laboratory Service, National Priority Program, Johannesburg, South Africa
| | - Koleka Mlisana
- National Health Laboratory Service, National Priority Program, Johannesburg, South Africa
| | - Helen E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Wendy S Stevens
- Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, National Priority Program, Johannesburg, South Africa
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Fofana AM, Moultrie H, Scott L, Jacobson KR, Shapiro AN, Dor G, Crankshaw B, Silva PD, Jenkins HE, Bor J, Stevens WS. Cross-municipality migration and spread of tuberculosis in South Africa. Sci Rep 2023; 13:2674. [PMID: 36792792 PMCID: PMC9930008 DOI: 10.1038/s41598-023-29804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Human migration facilitates the spread of infectious disease. However, little is known about the contribution of migration to the spread of tuberculosis in South Africa. We analyzed longitudinal data on all tuberculosis test results recorded by South Africa's National Health Laboratory Service (NHLS), January 2011-July 2017, alongside municipality-level migration flows estimated from the 2016 South African Community Survey. We first assessed migration patterns in people with laboratory-diagnosed tuberculosis and analyzed demographic predictors. We then quantified the impact of cross-municipality migration on tuberculosis incidence in municipality-level regression models. The NHLS database included 921,888 patients with multiple clinic visits with TB tests. Of these, 147,513 (16%) had tests in different municipalities. The median (IQR) distance travelled was 304 (163 to 536) km. Migration was most common at ages 20-39 years and rates were similar for men and women. In municipality-level regression models, each 1% increase in migration-adjusted tuberculosis prevalence was associated with a 0.47% (95% CI: 0.03% to 0.90%) increase in the incidence of drug-susceptible tuberculosis two years later, even after controlling for baseline prevalence. Similar results were found for rifampicin-resistant tuberculosis. Accounting for migration improved our ability to predict future incidence of tuberculosis.
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Affiliation(s)
- Abdou M Fofana
- Institute for Health System Innovation & Policy, Boston University, Questrom School of Business, Boston, USA.
- Boston University School of Public Health, Boston, USA.
| | - Harry Moultrie
- Centre for Tuberculosis, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Lesley Scott
- Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen R Jacobson
- Section of Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, USA
| | | | - Graeme Dor
- Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Beth Crankshaw
- Centre for Tuberculosis, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Pedro Da Silva
- National Health Laboratory Service, Johannesburg, South Africa
| | | | - Jacob Bor
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Boston University School of Public Health, Boston, USA
| | - Wendy S Stevens
- Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
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