Yield and Coverage of Active Case Finding Interventions for Tuberculosis Control:A Systematic Review and Meta-analysis.

Background. Active case finding (ACF) for tuberculosis (TB) is a key strategy to reduce diagnostic delays, expedite treatment, and prevent transmission. Objective. Our objective was to identify the populations, settings, screening and diagnostic approaches that optimize coverage (proportion of those targeted who were screened) and yield (proportion of those screened who had active TB) in ACF programs. Methods. We performed a comprehensive search to identify studies published from 1980-2016 that reported the coverage and yield of different ACF approaches. For each outcome, we conducted meta-analyses of single proportions to produce estimates across studies, followed by meta-regression to identify predictors. Findings. Of 3,972 publications identified, 224 met criteria after full-text review. Most individuals who were targeted successfully completed screening, for a pooled coverage estimate of 93.5%. The pooled yield of active TB across studies was 3.2%. Settings with the highest yield were internally-displaced persons camps (15.6%) and healthcare facilities (6.9%). When compared to symptom screening as the reference standard, studies that screened individuals regardless of symptoms using microscopy, culture, or GeneXpert®MTB/RIF (Xpert) had 3.7% higher case yield. In particular, microbiological screening (usually microscopy) as the initial test, followed by culture or Xpert for diagnosis had 3.6% higher yield than symptom screening followed by microscopy for diagnosis. In a model adjusted for use of Xpert testing, approaches targeting persons living with HIV (PLWH) had a 4.9% higher yield than those targeting the general population. In all models, studies targeting children had higher yield (4.8%-5.7%) than those targeting adults. Conclusion. ACF activities can be implemented successfully in various populations and settings. Screening yield was highest in internally-displaced person and healthcare settings, and among PLWH and children. In high-prevalence settings, ACF approaches that screen individuals with laboratory tests regardless of symptoms have higher yield than approaches focused on symptomatic individuals

Validation of an Online Mapping Methodology to Locate Village of Residence of Tuberculosis Patients in Mombasa

Thesis (Master's)--University of Washington, 2013University of Washington Abstract Validation of an Online Mapping Methodology to Locate Village of Residence of Tuberculosis Patients in Mombasa Ruth Wangui Deya Chair of the Supervisory Committee: Professor R. Scott McClelland Departments of Medicine, Epidemiology and Global Health BACKGROUND In Kenya, the dual TB-HIV epidemic has led to increasing morbidity and mortality especially in urban areas. National TB programs need to identify communities with the highest TB burden and to employ aggressive prevention measures such as intensive case finding and contact tracing in order to interrupt ongoing disease transmission. We evaluated the accuracy of an online mapping method to locate TB patients' village of residence using addresses provided in TB registers in Mombasa, Kenya. METHODS To validate the spatial accuracy of a health-worker-based online mapping procedure, we compared whether latitude and longitude point locations of TB patients matched those collected using a Global Positioning System (GPS) device during a home visit. Patient, clinic, and village-level characteristics associated with correct location in village of residence were evaluated using logistic regression. RESULTS Between July 2012 and July 2013, 246 participants who met study inclusion criteria were mapped using both methods. The online method located 140 cases (56.9%) in the correct village of residence, 80 (32.5%) and 26 (10.5%) were incorrectly allocated to a neighboring and non-neighboring village, respectively. The mean error distance between the two methods was 225.2m (±296.2) for all cases, 106.5m (±92.5) and 382m (±386.9) for those correctly located and incorrectly located, respectively. Type of clinic, clinic caseload, village status, and density were significantly associated with being correctly mapped to the village of residence in bivariate analysis. In multivariate analyses, medium caseloads (201 - 400 cases versus 0 - 200 cases per year; adjusted OR 2.75 95% CI 1.37 - 5.53; p 0.004); moderate number of households per village (1,001 - 2000 versus 0 - 1000 households; aOR 0.42 95% CI 0.21 - 0.85; p 0.016); high village density (>30,000 versus 0-15,000 per km2; aOR 0.43 95% CI 0.19 - 0.94; p 0.035) and attending municipal clinics (aOR 0.45 95% CI 0.20 - 0.99; p 0.048) were significantly associated with correct village location. DISCUSSION This online mapping tool correctly allocated almost 60% of TB cases in their village of residence while majority of misclassifications were cases located in neighboring villages. New mapping tools such as online Google Maps could be improved and employed in surveillance of TB cases for timely diagnosis, follow-up and treatment completion. Tuberculosis programs in dense urban areas with high caseload clinics may benefit from improving the quality of addresses obtained in their TB registers in order effectively implement intensive case finding and contact tracing activities

Genital HSV Shedding among Kenyan Women Initiating Antiretroviral Therapy.

Genital ulcer disease (GUD) prevalence increases in the first month of antiretroviral treatment (ART), followed by a return to baseline prevalence by month 3. Since most GUD is caused by herpes simplex virus type 2 (HSV-2), we hypothesized that genital HSV detection would follow a similar pattern after treatment initiation.We conducted a prospective cohort study of 122 HSV-2 and HIV-1 co-infected women with advanced HIV disease who initiated ART and were followed closely with collection of genital swab specimens for the first three months of treatment.At baseline, the HSV detection rate was 32%, without significant increase in genital HSV detection noted during the first month or the third month of ART. HIV-1 shedding declined during this period; no association was also noted between HSV and HIV-1 shedding during this period.Because other studies have reported increased HSV detection in women initiating ART and we have previously reported an increase in GUD during early ART, it may be prudent to counsel HIV-1 infected women initiating ART that HSV shedding in the genital tract may continue after ART initiation

Genital HIV-1 shedding and HSV detection during month one of ART.

<p>Line graph depicting the median vaginal HIV-1 viral load superimposed on a bar graph depicting the proportion of participants in whom genital HSV was detected at each time point.</p

Baseline Characteristics of HSV-2-Seropositive Women Initiating ART.

<p>Baseline Characteristics of HSV-2-Seropositive Women Initiating ART.</p

Characteristics Associated with Genital HSV Detection in Population 1.

<p>Characteristics Associated with Genital HSV Detection in Population 1.</p

Associations with Genital HSV Detection in Population 2.

<p>Associations with Genital HSV Detection in Population 2.</p