“I got tested at home, the help came to me”: acceptability and feasibility of home‐based TB testing of household contacts using portable molecular diagnostics in South Africa

Medina‐Marino, Andrew; Vos, Lindsey De; Bezuidenhout, Dana; Denkinger, Claudia M.; Schumacher, Samuel G; Shin, Sanghyuk S.; Stevens, Wendy; Theron, Grant; Walt, Martie van der; Daniels, Joseph

doi:10.1111/tmi.13533

Cited by 17 publications

(14 citation statements)

References 47 publications

(62 reference statements)

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“…Household members expressed a high level of comfort with the CHW-led home visits, a surprising finding given the high levels of crime reported in the area, but similar to previous work conducted in South African settings (Medina-Marino et al 2021 ; Ngcobo and Rossouw 2022 ), suggesting the trusted role that CHWs occupy in the community. Home-based tuberculosis testing, lasting as long as 2 hours, was acceptable due to its convenience (i.e., not having to make multiple trips to the health clinic) and receiving reliable information on the spot (Medina-Marino et al 2021 ). In another study, community members expressed greater receptivity for the home visits when informed of the role, age, and gender of the CHWs prior to the visit (Ngcobo and Rossouw 2022 ).…”

Section: Discussionsupporting

confidence: 80%

Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa

Stoutenberg

Crouch

McNulty

et al. 2023

J Public Health (Berl.)

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Background Low–middle-income countries (LMICs) face increasing burdens from non-communicable disease (NCDs) requiring primary care task shifting to community health workers (CHWs). This study explored community members' perceptions of NCD-focused, CHW-led home visits in a historically disadvantaged township of South Africa. Methods Trained CHWs visited community member homes, performing blood pressure and physical activity (PA) screenings, followed by brief counselling and a satisfaction survey. Semi-structured interviews were conducted within 3 days of the visit to learn about their experiences. Results CHWs visited 173 households, with 153 adult community members consenting to participate (88.4%). Participants reported that it was easy to understand CHW-delivered information (97%), their questions were answered well (100%), and they would request home service again (93%). Twenty-eight follow-up interviews revealed four main themes: 1) acceptance of CHW visits, 2) openness to counselling, 3) satisfaction with screening and a basic understanding of the results, and 4) receptiveness to the PA advice. Conclusion Community members viewed CHW-led home visits as an acceptable and feasible method for providing NCD-focused healthcare services in an under-resourced community. Expanding primary care reach through CHWs offers more accessible and individualized care, reducing barriers for individuals in under-resourced communities to access support for NCD risk reduction.

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Section: Discussionsupporting

confidence: 80%

Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa

Stoutenberg

Crouch

McNulty

et al. 2023

J Public Health (Berl.)

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“…For example, GeneXpert Edge is a portable battery-powered solution operated by a tablet able to do Ultra onsite in difficult-to-reach populations [ 79 ]. This can facilitate home-based testing, which patients can prefer to facility testing [ 80 ]. Fast-follower technologies like Truenat MTB (Molbio Diagnostics, India) are emerging with similar sensitivity and specificity to Xpert [ 14 ] (and Truenat MTB's successor MTB Plus, expected to have similar performance to Ultra) that can also be used in a portable battery-operated platform and is WHO-endorsed [ 81 , 82 ].…”

Section: Confirmatory Toolsmentioning

confidence: 99%

Diagnosing Tuberculosis: What Do New Technologies Allow Us to (Not) Do?

Abdulgader¹,

Ojo-Okunola²,

Ndlangalavu³

et al. 2022

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New tuberculosis (TB) diagnostics are at a crossroads: their development, evaluation, and implementation is severely damaged by resource diversion due to COVID-19. Yet several technologies, especially those with potential for non-invasive non-sputum-based testing, hold promise for efficiently triaging and rapidly confirming TB near point-of-care. Such tests are, however, progressing through the pipeline slowly and will take years to reach patients and health workers. Compellingly, such tests will create new opportunities for difficult-to-diagnose populations, including primary care attendees (all-comers in high burden settings irrespective of reason for presentation) and community members (with early stage disease or risk factors like HIV), many of whom cannot easily produce sputum. Critically, all upcoming technologies have limitations that implementers and health workers need to be cognizant of to ensure optimal deployment without undermining confidence in a technology that still offers improvements over the status quo. In this state-of-the-art review, we critically appraise such technologies for active pulmonary TB diagnosis. We highlight strengths, limitations, outstanding research questions, and how current and future tests could be used in the presence of these limitations and uncertainties. Among triage tests, CRP (for which commercial near point-of-care devices exist) and computer-aided detection software with digital chest X-ray hold promise, together with late-stage blood-based assays that detect host and/or microbial biomarkers; however, aside from a handful of prototypes, the latter category has a shortage of promising late-stage alternatives. Furthermore, positive results from new triage tests may have utility in people without TB; however, their utility for informing diagnostic pathways for other diseases is under-researched (most sick people tested for TB do not have TB). For confirmatory tests, few true point-of-care options will be available soon; however, combining novel approaches like tongue swabs with established tests like Ultra have short-term promise but first require optimizations to specimen collection and processing procedures. Concerningly, no technologies yet have compelling evidence of meeting the World Health Organization optimal target product profile performance criteria, especially for important operational criteria crucial for field deployment. This is alarming as the target product profile criteria are themselves almost a decade old and require urgent revision, especially to cater for technologies made prominent by the COVID-19 diagnostic response (e.g., at-home testing and connectivity solutions). Throughout the review, we underscore the importance of how target populations and settings affect test performance and how the criteria by which these tests should be judged vary by use case, including in active case finding. Lastly, we advocate for health workers and researchers to themselves be vocal proponents of the uptake of both new tests and those – already available tests that remain suboptimally utilized.

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“…The home-based approach to LTBI testing using IGRA could explain the high acceptability rates observed in our study. Similar home-based approaches in TB HHC investigation using other techniques like portable molecular diagnostics (portable GeneXpert-Instrument) [14] and home-based sputum collection [15] have showed that home-based approaches are convenient, trustworthy and help to overcome barriers to clinic-based testing like waiting time, distance and transportation costs.…”

Section: Discussionmentioning

confidence: 99%

Integrating interferon-gamma release assay testing into provision of tuberculosis preventive therapy is feasible in a tuberculosis high burden resource-limited setting: A mixed methods study

Muchuro

Makabayi-Mugabe

Musaazi

et al. 2022

PLOS Glob Public Health

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The World Health Organization recommends the scale-up of tuberculosis preventive therapy (TPT) for persons at risk of developing active tuberculosis (TB) as a key component to end the global TB epidemic. We sought to determine the feasibility of integrating testing for latent TB infection (LTBI) using interferon-gamma release assays (IGRAs) into the provision of TPT in a resource-limited high TB burden setting. We conducted a parallel convergent mixed methods study at four tertiary referral hospitals. We abstracted details of patients with bacteriologically confirmed pulmonary tuberculosis (PBC TB). We line-listed household contacts (HHCs) of these patients and carried out home visits where we collected demographic data from HHCs, and tested them for both HIV and LTBI. We performed multi-level Poisson regression with robust standard errors to determine the associations between the presence of LTBI and characteristics of HHCs. Qualitative data was collected from health workers and analyzed using inductive thematic analysis. From February to December 2020 we identified 355 HHCs of 86 index TB patients. Among these HHCs, uptake for the IGRA test was 352/355 (99%) while acceptability was 337/352 (95.7%). Of the 352 HHCs that were tested with IGRA, the median age was 18 years (IQR 10–32), 191 (54%) were female and 11 (3%) were HIV positive. A total of 115/352 (32.7%) had a positive IGRA result. Among HHCs who tested negative on IGRA at the initial visit, 146 were retested after 9 months and 5 (3.4%) of these tested positive for LTBI. At multivariable analysis, being aged ≥ 45 years [PR 2.28 (95% CI 1.02, 5.08)], being employed as a casual labourer [PR 1.38 (95% CI 1.19, 1.61)], spending time with the index TB patient every day [PR 2.14 (95% CI 1.51, 3.04)], being a parent/sibling to the index TB patients [PR 1.39 (95% CI 1.21, 1.60)] and sharing the same room with the index TB patients [PR 1.98 (95% CI 1.52, 2.58)] were associated with LTBI. Implementation challenges included high levels of TB stigma and difficulties in following strict protocols for blood sample storage and transportation. Integrating home-based IGRA testing for LTBI into provision of TB preventive therapy in routine care settings was feasible and resulted in high uptake and acceptability of IGRA tests.

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“I got tested at home, the help came to me”: acceptability and feasibility of home‐based TB testing of household contacts using portable molecular diagnostics in South Africa

Cited by 17 publications

References 47 publications

Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa

Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa

Diagnosing Tuberculosis: What Do New Technologies Allow Us to (Not) Do?

Integrating interferon-gamma release assay testing into provision of tuberculosis preventive therapy is feasible in a tuberculosis high burden resource-limited setting: A mixed methods study

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