1. Integrating molecular and radiological screening tools during community-based active case-finding for tuberculosis and COVID-19 in southern Africa.
- Author
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Scott, Alex John, Limbada, Mohammed, Perumal, Tahlia, Jaumdally, Shameem, Kotze, Andrea, van der Merwe, Charnay, Cheeba, Maina, Milimo, Deborah, Murphy, Keelin, van Ginneken, Bram, de Kock, Mariana, Warren, Robin Mark, Gina, Phindile, Swanepoel, Jeremi, Kühn, Louié, Oelofse, Suzette, Pooran, Anil, Esmail, Aliasgar, Ayles, Helen, and Dheda, Keertan
- Subjects
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MEDICAL screening , *COMPUTER-aided diagnosis , *COVID-19 , *AEROSOL sampling , *TUBERCULOSIS - Abstract
• Community-based integration of TB and COVID-19 screening is feasible. • Point-of-care molecular and radiological screening tools have high diagnostic yield. • This active case-finding strategy detects individuals with probably infectious TB. To evaluate diagnostic yield and feasibility of integrating testing for TB and COVID-19 using molecular and radiological screening tools during community-based active case-finding (ACF). Community-based participants with presumed TB and/or COVID-19 were recruited using a mobile clinic. Participants underwent simultaneous point-of-care (POC) testing for TB (sputum; Xpert Ultra) and COVID-19 (nasopharyngeal swabs; Xpert SARS-CoV-2). Sputum culture and SARS-CoV-2 RT-PCR served as reference standards. Participants underwent ultra-portable POC chest radiography with computer-aided detection (CAD). TB infectiousness was evaluated using smear microscopy, cough aerosol sampling studies (CASS), and chest radiographic cavity detection. Feasibility of POC testing was evaluated via user-appraisals. Six hundred and one participants were enrolled, with 144/601 (24.0%) reporting symptoms suggestive of TB and/or COVID-19. 16/144 (11.1%) participants tested positive for TB, while 10/144 (6.9%) tested positive for COVID-19 (2/144 [1.4%] had concurrent TB/COVID-19). Seven (7/16 [43.8%]) individuals with TB were probably infectious. Test-specific sensitivity and specificity (95% CI) were: Xpert Ultra 75.0% (42.8-94.5) and 96.9% (92.4-99.2); Xpert SARS-CoV-2 66.7% (22.3-95.7) and 97.1% (92.7-99.2). Area under the curve (AUC) for CAD4TB was 0.90 (0.82-0.97). User appraisals indicated POC Xpert to have 'good' user-friendliness. Integrating TB/COVID-19 screening during community-based ACF using POC molecular and radiological tools is feasible, has a high diagnostic yield, and can identity probably infectious persons. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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