A Cluster Randomized Trial of Systematic Targeted Universal Testing for Tuberculosis in Primary Care Clinics of South Africa (The TUTT Study)

Martinson, Neil; Genade, Leisha; Berhanu, Rebecca; Naidoo, Paramespri; Brey, Zameer; Kinghorn, Anthony; Nyathi, Sipho; Young, Katherine; Hausler, Harry; Connell, Lucy; Lutchminarain, Keeren; Swe-Han, Khine Swe; Vreede, Helena; Said, Mohamed; Knorring, Nina von; Moulton, Lawrence H.; Lebina, Limakatso

doi:10.2139/ssrn.4092970

Cited by 6 publications

(9 citation statements)

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“…This could have resulted in sampling bias as people willing to participate in a study may not accurately reflect clinic populations. In order to increase enrollment and minimize bias against the intervention in the primary outcome of the study, which was to determine if risk factor–based screening could increase the number of TB cases in a cluster randomized trial design [ 31 ], the interview and data collection process was kept short. Given the scale of the study (>30 000 participants in the intervention facilities), a long interview would have resulted in missed opportunities for recruitment.…”

Section: Discussionmentioning

confidence: 99%

“…In TUTT, we targeted clinic attendees with HIV, those who self-reported close contact with a TB patient, and those with a history of TB in the preceding 2 years [ 26–30 ]. The main findings of the TUTT trial have been reported elsewhere [ 31 ]. In this study, we report on the yield of testing and the performance of Xpert-Ultra Mycobacterium tuberculosis /rifampin (Xpert) relative to liquid culture in each of the 3 high-risk groups in the TUTT intervention arm [ 31 ].…”

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confidence: 99%

“…The main findings of the TUTT trial have been reported elsewhere [ 31 ]. In this study, we report on the yield of testing and the performance of Xpert-Ultra Mycobacterium tuberculosis /rifampin (Xpert) relative to liquid culture in each of the 3 high-risk groups in the TUTT intervention arm [ 31 ].…”

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confidence: 99%

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Yield of Facility-based Targeted Universal Testing for Tuberculosis With Xpert and Mycobacterial Culture in High-Risk Groups Attending Primary Care Facilities in South Africa

Berhanu

Lebina

Milovanovic

et al. 2023

Clinical Infectious Diseases

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Background We report the yield of targeted universal tuberculosis (TB) testing of clinic attendees in high-risk groups. Methods Clinic attendees in primary-healthcare facilities in South-Africa classified as high risk for TB due to the presence of one of the following risk factors: HIV-positive; contact of a patient with TB in the past year; and those with TB in the last two years underwent sputum testing for pulmonary TB. A single sample was collected for Xpert-Ultra (‘Xpert’) and culture. We report proportion positive for Mycobacterium tuberculosis. Data were analysed descriptively (counts, proportions and medians with interquartile range). The unadjusted clinical and demographic factors’ relative risk of TB detected by culture or Xpert were calculated and concordance between Xpert and culture is described. Findings A total of 30513 participants had a TB test result. Median age was 39, and 11553 (38%) were men. The majority (n = 21734, 71%) had HIV infection, 12492 (41%) reported close contact with a TB patient, and 1573 (5%) reported prior TB. Overall, 8.3% were positive for M. tuberculosis by culture and/or Xpert, compared to 6.0% with trace-positive results excluded. In asymptomatic participants the yield was 6.7% and 10.1% in symptomatic participants (with trace-positives excluded). Only 10% of trace-positive results were culture-positive. We found 55% of clinic attendees with a sputum result positive for M. tuberculosis did not have a positive TB symptom screen. Interpretation A high proportion of clinic attendees with specific risk factors (HIV; close TB contact; history of TB) test positive for M. tuberculosis when universal testing is implemented.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Yield of Facility-based Targeted Universal Testing for Tuberculosis With Xpert and Mycobacterial Culture in High-Risk Groups Attending Primary Care Facilities in South Africa

Berhanu

Lebina

Milovanovic

et al. 2023

Clinical Infectious Diseases

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“…Systematic Targeted Universal Testing for Tuberculosis (TUTT), implemented as a randomized trial from 2018 to 2020, found a 17% increase in TB diagnoses per month compared to the prior year after implementing routine TB testing for individuals with documented HIV infections, close contacts, or diagnosed TB in the prior two years 31 . The South African TB Prevalence Survey found that 57.7% of people with bacteriologically confirmed TB initially screened positive with chest x-ray alone 8 , without symptoms.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis testing patterns in South Africa to identify groups that would benefit from increased investigation

Shapiro,

Scott,

Moultrie

et al. 2023

Sci Rep

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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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“…4 Based on these findings, adults with a history of previous tuberculosis treatment were included as one of three highrisk groups eligible for facilitybased, targeted universal testing for tuberculosis in a large clusterrandomised trial. 5 Considering Moyo and colleague's findings, 1 we note that such targeted approaches could add substantial value to South Africa's fight against tuberculosis. Integrating prevention and case finding among previously treated people into national efforts to end tuberculosis should be a priority.…”

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confidence: 91%

National survey in South Africa reveals high tuberculosis prevalence among previously treated people

Marx

Hesseling

Martinson

et al. 2022

The Lancet Infectious Diseases

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A Cluster Randomized Trial of Systematic Targeted Universal Testing for Tuberculosis in Primary Care Clinics of South Africa (The TUTT Study)

Cited by 6 publications

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Yield of Facility-based Targeted Universal Testing for Tuberculosis With Xpert and Mycobacterial Culture in High-Risk Groups Attending Primary Care Facilities in South Africa

Yield of Facility-based Targeted Universal Testing for Tuberculosis With Xpert and Mycobacterial Culture in High-Risk Groups Attending Primary Care Facilities in South Africa

Tuberculosis testing patterns in South Africa to identify groups that would benefit from increased investigation

National survey in South Africa reveals high tuberculosis prevalence among previously treated people

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