Mary Wilson
Well-known member
Published: 10 February 2025
Open Forum Infectious Diseases, ofaf077, https://doi.org/10.1093/ofid/ofaf077
Lilian N Njagi, Khai Hoan Tram, Jerry S Zifodya, Sharmila Paul, Jennifer M Ross, Wilfred Murithi, Zipporah Mwongera, Richard Kiplimo, Jane R Ong’ang’o, Kevin P Fennelly, Thomas R Hawn, Videlis Nduba, David J Horne
Abstract
Background
The role of active case-finding (ACF) in improving TB prevention and care depends on the infectiousness of persons with undiagnosed TB and the accuracy of screening strategies. To compare undiagnosed community dwellers to persons presenting for healthcare, we evaluated clinicodemographic and microbiologic characteristics, cough aerosol culture (CAC) status, and household contact (HHC) QuantiFERON-Plus (QFT) status by case-finding approach in adults with pulmonary TB.
Methods
We enrolled 388 Kenyan adults with GeneXpert (excluding trace) and/or culture-confirmed, untreated TB through healthcare presentation (passive case-finding (PCF), 87%) or ACF (community-based prevalence survey). Interventions included cough aerosol sampling and HHCs QFT testing. We performed mixed-effect logistic regression to predict transmission, clustered on index participants.
Results
WHO-recommended screening symptoms (W4SS) were more common in the PCF cohort (99% versus 73%, p<0.001). Traditional makers of infectiousness were less frequent in the ACF cohort. Higher symptom burden (number of reported W4SS) associated with higher bacillary burden (lower GeneXpert Ct) (estimate -0.55, 95% confidence interval (CI) -0.98 to -0.13; p=0.01). Among 263 participants with CAC, 21% were CAC-positive, none of whom enrolled through ACF. Among 270 HHCs, QFT-positivity differed by index CAC-status (89% versus 56% in HHCs of CAC-positive and negative participants, respectively, p<0.001) but not by traditional infectiousness makers or case-finding approach. Index CAC-positive status (adjusted odds ratio (aOR) 11.2, CI 2.2–58.3), HIV-positive status (aOR 0.1, CI 0.0–0.6), and HHCs age (aOR 1.04, CI 1.01–1.08), independently predicted HHC QFT-positivity.
Conclusion
Our findings suggest that ACF may detect a smaller proportion of CAC-positive persons with TB than PCF
https://watermark.silverchair.com/o...kmtg1zBKL2XgzBM_X5hIxRL0EpgVOzN8Mh0BKpcF-817K
Open Forum Infectious Diseases, ofaf077, https://doi.org/10.1093/ofid/ofaf077
Lilian N Njagi, Khai Hoan Tram, Jerry S Zifodya, Sharmila Paul, Jennifer M Ross, Wilfred Murithi, Zipporah Mwongera, Richard Kiplimo, Jane R Ong’ang’o, Kevin P Fennelly, Thomas R Hawn, Videlis Nduba, David J Horne
Abstract
Background
The role of active case-finding (ACF) in improving TB prevention and care depends on the infectiousness of persons with undiagnosed TB and the accuracy of screening strategies. To compare undiagnosed community dwellers to persons presenting for healthcare, we evaluated clinicodemographic and microbiologic characteristics, cough aerosol culture (CAC) status, and household contact (HHC) QuantiFERON-Plus (QFT) status by case-finding approach in adults with pulmonary TB.
Methods
We enrolled 388 Kenyan adults with GeneXpert (excluding trace) and/or culture-confirmed, untreated TB through healthcare presentation (passive case-finding (PCF), 87%) or ACF (community-based prevalence survey). Interventions included cough aerosol sampling and HHCs QFT testing. We performed mixed-effect logistic regression to predict transmission, clustered on index participants.
Results
WHO-recommended screening symptoms (W4SS) were more common in the PCF cohort (99% versus 73%, p<0.001). Traditional makers of infectiousness were less frequent in the ACF cohort. Higher symptom burden (number of reported W4SS) associated with higher bacillary burden (lower GeneXpert Ct) (estimate -0.55, 95% confidence interval (CI) -0.98 to -0.13; p=0.01). Among 263 participants with CAC, 21% were CAC-positive, none of whom enrolled through ACF. Among 270 HHCs, QFT-positivity differed by index CAC-status (89% versus 56% in HHCs of CAC-positive and negative participants, respectively, p<0.001) but not by traditional infectiousness makers or case-finding approach. Index CAC-positive status (adjusted odds ratio (aOR) 11.2, CI 2.2–58.3), HIV-positive status (aOR 0.1, CI 0.0–0.6), and HHCs age (aOR 1.04, CI 1.01–1.08), independently predicted HHC QFT-positivity.
Conclusion
Our findings suggest that ACF may detect a smaller proportion of CAC-positive persons with TB than PCF
https://watermark.silverchair.com/o...kmtg1zBKL2XgzBM_X5hIxRL0EpgVOzN8Mh0BKpcF-817K