1
|
Leukes VN, Hella J, Sabi I, Cossa M, Khosa C, Erkosar B, Mangu C, Siyame E, Mtafya B, Lwilla A, Viegas S, Madeira C, Machiana A, Ribeiro J, Garcia-Basteiro AL, Riess F, Elísio D, Sasamalo M, Mhalu G, Denkinger CM, Castro MDM, Bashir S, Schumacher SG, Tagliani E, Malhotra A, Dowdy D, Schacht C, Buech J, Nguenha D, Ntinginya N, Ruhwald M, Penn-Nicholson A, Kranzer K. Study protocol: a pragmatic, cluster-randomized controlled trial to evaluate the effect of implementation of the Truenat platform/MTB assays at primary health care clinics in Mozambique and Tanzania (TB-CAPT CORE). BMC Infect Dis 2024; 24:107. [PMID: 38243223 PMCID: PMC10797907 DOI: 10.1186/s12879-023-08876-8] [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: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In 2020, the WHO-approved Molbio Truenat platform and MTB assays to detect Mycobacterium tuberculosis complex (MTB) and resistance to rifampicin directly on sputum specimens. This primary health care center-based trial in Mozambique and Tanzania investigates the effect of Truenat platform/MTB assays (intervention arm) combined with rapid communication of results compared to standard of care on TB diagnosis and treatment initiation for microbiologically confirmed TB at 7 days from enrolment. METHODS The Tuberculosis Close the Gap, Increase Access, and Provide Adequate Therapy (TB-CAPT) CORE trial employs a pragmatic cluster randomized controlled design to evaluate the impact of a streamlined strategy for delivery of Truenat platform/MTB assays testing at primary health centers. Twenty-nine centers equipped with TB microscopy units were selected to participate in the trial. Among them, fifteen health centers were randomized to the intervention arm (which involves onsite molecular testing using Truenat platform/MTB assays, process process optimization to enable same-day TB diagnosis and treatment initiation, and feedback on Molbio platform performance) or the control arm (which follows routine care, including on-site sputum smear microscopy and the referral of sputum samples to off-site Xpert testing sites). The primary outcome of the study is the absolute number and proportion of participants with TB microbiological confirmation starting TB treatment within 7 days of their first visit. Secondary outcomes include time to bacteriological confirmation, health outcomes up to 60 days from first visit, as well as user preferences, direct cost, and productivity analyses. ETHICS AND DISSEMINATION TB-CAPT CORE trial has been approved by regulatory and ethical committees in Mozambique and Tanzania, as well as by each partner organization. Consent is informed and voluntary, and confidentiality of participants is maintained throughout. Study findings will be presented at scientific conferences and published in peer-reviewed international journals. TRIAL REGISTRATION US National Institutes of Health's ClinicalTrials.gov, NCT04568954. Registered 23 September 2020.
Collapse
Affiliation(s)
| | - J Hella
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - I Sabi
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - M Cossa
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - C Khosa
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | | | - C Mangu
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - E Siyame
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - B Mtafya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - A Lwilla
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - S Viegas
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - C Madeira
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - A Machiana
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - J Ribeiro
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - A L Garcia-Basteiro
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - F Riess
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany
| | - D Elísio
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - M Sasamalo
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - G Mhalu
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - C M Denkinger
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | - M D M Castro
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | - S Bashir
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | | | - E Tagliani
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Malhotra
- Johns Hopkins University (JHU), Baltimore, MD, USA
| | - D Dowdy
- Johns Hopkins University (JHU), Baltimore, MD, USA
| | | | - J Buech
- LINQ Management, Berlin, Germany
| | - D Nguenha
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - N Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | | | | | - K Kranzer
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany.
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
2
|
Cossa M, Nguenha D, Houana A, Ehrlich J, Acácio S, Garcia-Basteiro AL. The urgent need to improve on low implementation rates for TB preventive treatment for people living with HIV. Int J Tuberc Lung Dis 2024; 28:1-2. [PMID: 38178301 DOI: 10.5588/ijtld.23.0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Affiliation(s)
- M Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - D Nguenha
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - A Houana
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - J Ehrlich
- ISGlobal, Hospital Clínic, Universitat de Barcelona
| | - S Acácio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | | |
Collapse
|
3
|
Nguenha D, Cossa M, Acácio S, Garcia-Basteiro AL. Scaling up shorter TB preventive treatment is long overdue. Int J Tuberc Lung Dis 2022; 26:699-701. [PMID: 35898136 DOI: 10.5588/ijtld.22.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- D Nguenha
- Centro de Investigação em Saúde de Manhiça, Maputo, Moçambique
| | - M Cossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Moçambique
| | - S Acácio
- Centro de Investigação em Saúde de Manhiça, Maputo, Moçambique
| | - A L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Moçambique;, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, >Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| |
Collapse
|
4
|
Nguenha D, Acacio S, Murias-Closas A, Ramanlal N, Saavedra B, Karajeanes E, Mudumane B, Mambuque E, Gomes N, Losada I, Oliveras L, Naueia E, Sterling TR, Amorim G, Moon TD, Menéndez C, Vaz P, López-Varela E, Garcia-Basteiro AL. Prevalence and clinical characteristics of pulmonary TB among pregnant and post-partum women. Int J Tuberc Lung Dis 2022; 26:641-649. [PMID: 35768920 DOI: 10.5588/ijtld.21.0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Antenatal care (ANC) and postpartum care (PPC) clinic in Manhiça District, Mozambique.OBJECTIVE: To estimate the prevalence of TB among pregnant and post-partum women and describe the clinical characteristics of the disease in a rural area of Southern Mozambique.METHODS: We conducted a cross-sectional TB prevalence study among pregnant and post-partum women recruited from September 2016 to March 2018 at the Manhiça Health Care Center (MHC). We recruited two independent cohorts of women consecutively presenting for routine pregnancy or post-partum follow-up visits.RESULTS: A total of 1,980 women from the ANC clinic and 1,010 from the PPC clinic were enrolled. We found a TB prevalence of 505/100,000 (95% CI: 242-926) among pregnant women and 297/100,000 (95% CI: 61-865) among post-partum women. Among HIV-positive pregnant women, TB prevalence was 1,626/100,000 (95% CI: 782-2,970) and among postpartum HIV-positive women, TB prevalence was 984/100,000 (95% CI: 203-2,848).CONCLUSIONS: The burden of TB was not higher in postpartum women than in pregnant women. Most TB cases were detected in HIV-positive women. TB screening and diagnostic testing among pregnant and postpartum women attending ANC and PPC clinics in Manhiça District is acceptable and feasible.
Collapse
Affiliation(s)
- D Nguenha
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - S Acacio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - A Murias-Closas
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - N Ramanlal
- Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique
| | - B Saavedra
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - E Karajeanes
- Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique
| | - B Mudumane
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - E Mambuque
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - N Gomes
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - I Losada
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - L Oliveras
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, Agència de Salut Pública de Barcelona, Barcelona, Spain, Institut d´Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - E Naueia
- Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique
| | - T R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA, Vanderbilt Tuberculosis Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - G Amorim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T D Moon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C Menéndez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - P Vaz
- Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique
| | - E López-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| |
Collapse
|
5
|
Nguenha D, Garcia JI, Cowan JF, Garcia-Basteiro AL. Spatial epidemiology for tuberculosis surveillance: a relevant add-on to routine surveillance. Int J Tuberc Lung Dis 2019; 23:278-279. [DOI: 10.5588/ijtld.19.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- D. Nguenha
- Centro de Investigação em Saude de Manhiça, Vila da Manhiça, Maputo Province, Mozambique
| | - J. I. Garcia
- Centro de Investigação em Saude de Manhiça, Vila da Manhiça, Maputo Province, Mozambique, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - J. F. Cowan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - A. L. Garcia-Basteiro
- Centro de Investigação em Saude de Manhiça, Vila da Manhiça, Maputo Province, Mozambique, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, Amsterdam Institute for Global Health
and Development, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|