Number needed to screen for different study populations.

Number needed to screen for different study populations.</p

Comparative of CITS model parameters based on quarterly notification rates for all cases (first column) and just bacteriologically confirmed TB cases (second column), evaluating the Xpatial-TB intervention in comparison with the control area.

Comparative of CITS model parameters based on quarterly notification rates for all cases (first column) and just bacteriologically confirmed TB cases (second column), evaluating the Xpatial-TB intervention in comparison with the control area.</p

Interrupted time-series for single and multiple-group comparison.

Interrupted time-series for single and multiple-group comparison.</p

Xpatial tb master.

Prompt diagnosis is critical for tuberculosis (TB) control, as it enables early treatment which in turn, reduces transmission and improves treatment outcomes. We investigated the impact on TB diagnosis of introducing Xpert Ultra as the frontline diagnostic test, combined with an innovative active-case finding (ACF) strategy (based on Xpert Ultra semi-quantitative results and spatial parameters), in a semi-rural district of Southern Mozambique. From January-December 2018 we recruited incident TB-cases (index cases, ICs) and their household contacts (HCs). Recruitment of close community contacts (CCs) depended on IC´s Xpert Ultra results, and the population density of their area. TB-contacts, either symptomatic or people living with HIV, were asked to provide a spot sputum for lab-testing. Trends on TB case notification were compared to the previous years and to those of two districts in the south of the Maputo province (control area), using an interrupted time series analysis with and without control (CITS/ITS). A total of 1010 TB ICs (37.1% laboratory-confirmed) were recruited; 3165 HCs and 4730 CCs were screened for TB. Eighty-nine additional TB cases were identified through the ACF intervention (52.8% laboratory-confirmed). The intervention increased by 8.2% all forms of TB cases detected in 2018. Xpert Ultra trace positive results accounted for a high proportion of laboratory confirmations in the ACF cohort (51.1% vs 13.7% of those passively diagnosed). The Number Needed to Screen to find a TB case differed widely among HCs (55) and CCs (153). During the intervention period, a reversal of the previous negative trend in lab-confirmed case notifications was observed in the district. However, the CITS model did not show any statistically significant difference compared to the control area. Paediatric population benefited the most from the ACF strategy and HCs screening seemed an effective intervention to find microbiological confirmed cases in early stages of the disease.</div

Controlled interrupted series analysis (CITS) for bacteriologically confirmed cases.

Source of data: notification records from the National TB Programme. Control area: Districts of Namaacha and Matutuine, South Maputo; intervention area: Manhiça district. The pre-intervention period shows 3-years trend for reported confirmed cases. Dashed lines represent modelled trend (counterfactual estimates).</p

Visualization of interrupted time series analysis for Manhiça district.

Fig A. Visualization of interrupted time series analysis for Manhiça district (notification of total number of cases), Fig B. Visualization of interrupted time series analysis for Manhiça district (notification of microbiologically confirmed cases). (DOCX)</p

Xpatial algorithm.

1 NTP: National TB Programme; 2HCs: household contacts; 3CCs: close community contacts; 4PT: Preventive therapy. The Active Case Finding Intervention had 5 steps: I) HIV testing; (II) Screening of TB symptoms; (III) Ultra testing for those accomplishing criteria (HIV positive regardless symptoms or symptomatic contacts); (IV) identified TB cases were referred to the NTP to started on treatment; (V) children < 5 years old were referred to started preventive therapy.</p

Absolute numbers to calculate NNS (number needed to screen).

Absolute numbers to calculate NNS (number needed to screen).</p

Process indicators.

PCF: Passive Case Finding; ACF: Active Case Finding; Microb conf: microbiologically confirmed.</p

Characteristics of screened household and community contact.

Characteristics of screened household and community contact.</p