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Saavedra B, Nguenha D, de la Torre-Pérez L, Mambuque E, Tembe G, Oliveras L, Rudd M, Philimone P, Jose B, Garcia JI, Gomes N, Munguambe S, Chiconela H, Nhanommbe M, Izco S, Acacio S, García-Basteiro AL. Improving tuberculosis case detection through contact risk stratification by Xpert MTB/RIF Ultra and spatial parameters: Evaluation of an innovative active case finding strategy in Mozambique (Xpatial-TB). PLOS Glob Public Health 2024; 4:e0002789. [PMID: 38335231 PMCID: PMC10857722 DOI: 10.1371/journal.pgph.0002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/13/2023] [Indexed: 02/12/2024]
Abstract
Prompt diagnosis is critical for tuberculosis (TB) control, as it enables early treatment which in turn, reduces transmission and improves treatment outcomes. We investigated the impact on TB diagnosis of introducing Xpert Ultra as the frontline diagnostic test, combined with an innovative active-case finding (ACF) strategy (based on Xpert Ultra semi-quantitative results and spatial parameters), in a semi-rural district of Southern Mozambique. From January-December 2018 we recruited incident TB-cases (index cases, ICs) and their household contacts (HCs). Recruitment of close community contacts (CCs) depended on IC´s Xpert Ultra results, and the population density of their area. TB-contacts, either symptomatic or people living with HIV, were asked to provide a spot sputum for lab-testing. Trends on TB case notification were compared to the previous years and to those of two districts in the south of the Maputo province (control area), using an interrupted time series analysis with and without control (CITS/ITS). A total of 1010 TB ICs (37.1% laboratory-confirmed) were recruited; 3165 HCs and 4730 CCs were screened for TB. Eighty-nine additional TB cases were identified through the ACF intervention (52.8% laboratory-confirmed). The intervention increased by 8.2% all forms of TB cases detected in 2018. Xpert Ultra trace positive results accounted for a high proportion of laboratory confirmations in the ACF cohort (51.1% vs 13.7% of those passively diagnosed). The Number Needed to Screen to find a TB case differed widely among HCs (55) and CCs (153). During the intervention period, a reversal of the previous negative trend in lab-confirmed case notifications was observed in the district. However, the CITS model did not show any statistically significant difference compared to the control area. Paediatric population benefited the most from the ACF strategy and HCs screening seemed an effective intervention to find microbiological confirmed cases in early stages of the disease.
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Affiliation(s)
- Belén Saavedra
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Dinis Nguenha
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Laura de la Torre-Pérez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Edson Mambuque
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Gustavo Tembe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Laura Oliveras
- Agència de Salut Pública de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) Barcelona, Catalonia, Spain
| | - Matthew Rudd
- Department of Mathematics and Computer Science, The University of the South, Sewanee, Tennessee, United States of America
| | - Paulo Philimone
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Benedita Jose
- National Tuberculosis Control Programme, Maputo, Mozambique
| | - Juan Ignacio Garcia
- Population Health Program Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Neide Gomes
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Shilzia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Helio Chiconela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- National Tuberculosis Control Programme, Maputo, Mozambique
| | - Milton Nhanommbe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Santiago Izco
- STD/HIV/Aids and Tuberculosis department, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Sozinho Acacio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Alberto L. García-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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de la Torre-Pérez L, Oliver-Parra A, Torres X, Bertran MJ. How do we measure gender discrimination? Proposing a construct of gender discrimination through a systematic scoping review. Int J Equity Health 2022; 21:1. [PMID: 34980116 PMCID: PMC8722302 DOI: 10.1186/s12939-021-01581-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Gender discrimination (GD) has been frequently linked to mental health. The heterogeneity of how GD is defined has led to variation around the analysis of GD. This might affect the study of the association between GD and health outcomes. The main goal of this systematic scoping review is to operationalize the definition of the GD construct. METHODS Three search strategies were set in Pubmed, CINAHL and PsycINFO. The first strategy obtained results mainly about women, while the second focused on men. The third strategy focused on the identification of GD questionnaires. The prevalence of GD, factors and consequences associated with GD perception, and forms of discrimination were the principal variables collected. Risk of bias was assessed (PROSPERO:CRD42019120719). RESULTS Of the 925 studies obtained, 84 were finally included. 60 GD questionnaires were identified. GD prevalence varied between 3.4 and 67 %. Female gender and a younger age were the factors most frequently related to GD. Poorer mental health was the most frequent consequence. Two components of the GD construct were identified: undervaluation (different recognition, opportunities in access, evaluation standards and expectations) and different treatment (verbal abuse and behaviour). CONCLUSIONS Two-component GD definition can add order and precision to the measurement, increase response rates and reported GD.
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Affiliation(s)
- Laura de la Torre-Pérez
- Preventive Medicine and Epidemiology Department, Hospital Clínic de Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Alba Oliver-Parra
- Consorci Sanitari de Barcelona, Carrer d’Esteve Terradas, 08023 Barcelona, Spain
| | - Xavier Torres
- Clinical Health Psychology Section of the Institute Clinic of Neuroscience, Hospital Clínic de Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Maria Jesús Bertran
- Preventive Medicine and Epidemiology Department, Hospital Clínic de Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
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