The mass miniature chest radiography  programme in Cape Town, South Africa, 1948 - 1994: The impact of active tuberculosis case finding

Hermans, Sabine; Andrews, Joseph; Bekker, Linda‐Gail; Wood, Robin

doi:10.7196/samj.2017.v106i12.10744

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…However, far less progress has been made in finding and treating tuberculosis among people living with HIV and among HIV-negative people living in settings with high prevalence of coinfection, both forms of progress are imperative for control, and ultimately, for the elimination of tuberculosis 3 . To find individuals with infectious tuberculosis earlier requires a greater awareness of the risk of tuberculosis among people living with HIV and a more active approach to tuberculosis diagnosis at home, in the community and in health facilities 29 – 32 …”

Section: Discussionmentioning

confidence: 99%

Tuberculosis decline in populations affected by HIV: a retrospective study of 12 countries in the WHO African Region

Dye

Williams

2019

Bull. World Health Organ.

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Objective To investigate which of the World Health Organization recommended methods for tuberculosis control have had the greatest effect on case incidence in 12 countries in the World Health Organization (WHO) African Region that carry high burdens of tuberculosis linked to human immunodeficiency virus (HIV) infection. Methods We obtained epidemiological surveillance, survey and treatment data on HIV and tuberculosis for the years 2003 to 2016. We used statistical models to examine the effects of antiretroviral therapy (ART) and isoniazid preventive therapy in reducing the incidence of tuberculosis among people living with HIV. We also investigated the role of tuberculosis case detection and treatment in preventing Mycobacterium tuberculosis transmission and consequently reducing tuberculosis incidence. Findings Between 2003 and 2016, ART provision was associated with the decline of tuberculosis in each country, and with differences in tuberculosis decline between countries. Inferring that ART was a cause of tuberculosis decline, ART prevented 1.88 million (95% confidence interval, CI: 1.65 to 2.11) tuberculosis cases in people living with HIV, or 15.7% (95% CI: 13.8 to 17.6) of the 11.96 million HIV-positive tuberculosis cases expected. Population coverage of isoniazid preventive therapy was too low (average 1.0% of persons eligible) to have a major effect on tuberculosis decline, and improvements in tuberculosis detection and treatment were either weakly associated or not significantly associated with tuberculosis decline. Conclusion ART provision is associated with tuberculosis decline in these 12 countries. ART should remain central to tuberculosis control where rates of tuberculosis–HIV coinfection are high, but renewed efforts to treat tuberculosis are needed.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis decline in populations affected by HIV: a retrospective study of 12 countries in the WHO African Region

Dye

Williams

2019

Bull. World Health Organ.

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“…Chest radiography is among the oldest tools for pulmonary TB screening and historically played a major role in TB control programs in high burden settings (4,5). However, by the 1970s, concerns were raised about the accuracy, logistics and personnel requirements for mass radiography, leading the WHO to conclude in its 9 th expert committee report that "indiscriminate TB case finding by mobile mass radiography should be abandoned" (6).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of chest X-Ray with automated interpretation algorithms for mass tuberculosis screening in prisons

Soares

Oliveira

Liu

et al. 2021

Preprint

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Rationale: The World Health Organization (WHO) recommends systematic tuberculosis (TB) screening in prisons. Evidence is lacking for accurate and scalable screening approaches in this setting. Objectives: To assess the diagnostic accuracy of artificial intelligence-based chest x-ray interpretation algorithms for TB screening in prisons. Methods: Prospective TB screening study in three prisons in Brazil from October 2017 to December 2019. We administered a standardized questionnaire, performed chest x-ray in a mobile unit, and collected sputum for confirmatory testing using Xpert MTB/RIF and culture. We evaluated x-ray images using three algorithms (CAD4TB version 6, LunitTB and qXR) and compared their diagnostic accuracy. We utilized multivariable logistic regression to assess the effect of demographic and clinical characteristics on algorithm accuracy. Finally, we investigated the relationship between abnormality scores and Xpert semi-quantitative results. Measurements and Main Results: Among 2,075 incarcerated individuals, 259 (12.5%) had confirmed TB. All three algorithms performed similarly overall with AUCs of 0.87-0.91. At 90% sensitivity, only LunitTB and qXR met the WHO Target Product Profile requirements for a triage test, with specificity of 84% and 74%, respectively. All algorithms had variable performance by age, prior TB, smoking, and presence of TB symptoms. LunitTB was the most robust to this heterogeneity, but nonetheless failed to meet the TPP for individuals with previous TB. Abnormality scores of all three algorithms were significantly correlated with sputum bacillary load. Conclusions: Automated x-ray interpretation algorithms can be an effective triage tool for TB screening in prisons. However, their specificity is insufficient in individuals with previous TB.

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Contribution of Reinfection to Annual Rate of Tuberculosis Infection (ARI) and Incidence of Tuberculosis Disease

Horsburgh

Nichols

et al. 2022

Clinical Infectious Diseases

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Background Modeling studies have concluded that 60-80% of tuberculosis (TB) infections result from reinfection of previously infected persons. Annual Rate of Infection (ARI), a standard measure of the risk of TB infection in a community, may not accurately reflect the true risk of infection among previously-infected persons. We constructed a model of infection and re-infection with M. tuberculosis to explore the predictive accuracy of ARI and its effect on disease incidence. Methods We created a deterministic simulation of the progression from TB infection to disease and simulated the prevalence of TB infection at the beginning and end of a theoretical year of infection. We considered ten disease prevalence scenarios ranging from 100/100,000 to 1000/100,000 in simulations where TB exposure probability was homogeneous across the whole simulated population or heterogeneously stratified into high-risk and low-risk groups. ARI values, rates of progression from infection to disease and the effect of multiple reinfections were obtained from published studies. Results With homogenous exposure risk, observed ARI values produced expected numbers of infections. However, when heterogeneous risk was introduced, observed ARI was seen to underestimate true ARI by 25-58%. Of the cases of TB that occurred, 36% were among previously infected persons when prevalence was 100/100,000, increasing to 79% of cases when prevalence was 1,000/100,000. Conclusions Measured ARI underestimates true ARI as a result of heterogenous population mixing. The true force of infection in a community may be greater than previously appreciated. Hyperendemic communities likely contribute disproportionally to the global TB disease burden.

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The mass miniature chest radiography programme in Cape Town, South Africa, 1948 - 1994: The impact of active tuberculosis case finding

Cited by 5 publications

References 4 publications

Tuberculosis decline in populations affected by HIV: a retrospective study of 12 countries in the WHO African Region

Tuberculosis decline in populations affected by HIV: a retrospective study of 12 countries in the WHO African Region

Evaluation of chest X-Ray with automated interpretation algorithms for mass tuberculosis screening in prisons

Contribution of Reinfection to Annual Rate of Tuberculosis Infection (ARI) and Incidence of Tuberculosis Disease

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