Impact of active case-finding for tuberculosis on case-notifications in Blantyre, Malawi
A community-based cluster-randomised trial (SCALE)
Bibliographic Data
| ID | 19594166 |
|---|---|
| Authors | Helena R A Feasey (0000-0003-3109-6722, London School of Hygiene & Tropical Medicine, corresponding author), McEwen Khundi (0000-0003-2718-7576, African Institute for Development Policy, corresponding author), Rebecca Nzawa Soko (0000-0001-6804-186X, University of Liverpool, corresponding author), Christian Bottomley (0000-0002-5241-8412, London School of Hygiene & Tropical Medicine, corresponding author), Lingstone Chiume (0000-0002-3893-7814, University of Liverpool, corresponding author), Helen Burchett (0000-0002-8380-2476, London School of Hygiene & Tropical Medicine, corresponding author), Marriott Nliwasa (0000-0002-3100-5512, University of Liverpool, corresponding author), Hussein H Twabi (0000-0003-4473-296X, University of Liverpool, corresponding author), James Mpunga (corresponding author), James A Mpunga, Peter MacPherson (0000-0002-0329-9613, University of Glasgow, corresponding author), Elizabeth L Corbett (0000-0002-3552-3181, London School of Hygiene & Tropical Medicine, corresponding author) |
| Editors | Alice Zwerling (0000-0003-1613-8525) |
| Year | 2023 |
| Volume | 3 |
| Issue | 12 |
| Pages | e0002683 |
| Publication date | 2023-12-05 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | PLOS Global Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2767-3375 • E-ISSN: 2767-3375 |
| Publisher | Public Library of Science (PLoS) (PUBLISHER) |
| DOI | 10.1371/journal.pgph.0002683 |
| PMID | 38051717 |
| OpenAlex | W4389332159 |
| Language | EN |
| Citations received | 2 |
| References cited | 26 |
Active case-finding (ACF) for tuberculosis can help find the “missing millions” with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively implemented following 2014 estimates of ~1,000 per 100,000 adults with undiagnosed TB. Following a pre-intervention prevalence survey (May 2019 to March 2020), constrained randomisation allocated neighbourhoods to either door-to-door ACF (sputum microscopy for reported cough >2 weeks) or standard-of-care (SOC). Implementation was interrupted by COVID-19. Cluster-level bacteriologically-confirmed case-notification rate (CNR) ratio within 91 days of ACF was our redefined primary outcome; comparison between arms used Poisson regression with random effects. Secondary outcomes were 91-day CNR ratios comparing all tuberculosis registrations and all non-ACF registrations. Interrupted time series (ITS) analysis of CNRs in the SOC arm examined prevalence survey impact. (ISRCTN11400592). 72 clusters served by 10 study-supported tuberculosis registration centres were randomised to ACF (261,244 adults, 58,944 person-years follow-up) or SOC (256,713 adults, 52,805 person-years). Of 1,192 ACF participants, 13 (1.09%) were smear-positive. Within 91 days, 113 (42 bacteriologically-confirmed) and 108 (33 bacteriologically-confirmed) tuberculosis patients were identified as ACF or SOC cluster residents, respectively. There was no difference by arm, with adjusted 91-day CNR ratios 1.12 (95% CI: 0.61–2.07) for bacteriologically-confirmed tuberculosis; 0.93 (95% CI: 0.68–1.28) for all tuberculosis registrations; and 0.86 (95%CI: 0.63–1.16) for non-ACF (routinely) diagnosed. Of 7,905 ACF and 7,992 SOC pre-intervention survey participants, 12 (0.15%) and 17 (0.21%), respectively, had culture/Xpert-confirmed tuberculosis. ITS analysis showed no survey impact on SOC CNRs. Despite residual undiagnosed tuberculosis of 150 per 100,000 population, there was no increase in tuberculosis notifications from this previously successful approach targeting symptomatic disease, likely due to previous TB ACF and rapid declines in TB burden. In such settings, future ACF should focus on targeted outreach and demand creation, alongside optimised facility-based screening. Trial Registration : ISRCTN11400592
Case finding · Cluster randomised controlled trial · Confidence interval · Environmental health · Pathology · Poisson regression · Population · Randomized controlled trial · Sputum · Tuberculosis · Data-Driven Disease Surveillance · Medicine · Pneumonia and Respiratory Infections · Tuberculosis Research and Epidemiology · Internal Medicine · Pediatrics
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Prevalence of bacteriologically-confirmed pulmonary tuberculosis in urban Blantyre, Malawi 2019–20
| Citations per year | 0.67 |
|---|---|
| Citation span | 2023 - 2025 (3) |
| Highly cited | No |