Community-wide Screening for Tuberculosis in a High-Prevalence Setting

Marks, Guy B.; Nguyen, Nhung Viet; Nguyen, Phuong Chi; Nguyen, Thu-Anh; Nguyen, Hoa B.; Tran, Khoa Hien; Nguyen, Son; Luu, Khanh Boi; Tran, Duc T. T.; Vo, Qui T. N.; Le, Oanh T. T.; Nguyen, Yen H.; Quang, Vu; Mason, Paul H.; Nguyen, Van Anh Thi; Ho, Jennifer; Sintchenko, Vitali; Nguyen, Linh Nhat; Britton, Warwick J.; Fox, Greg J.

doi:10.1056/nejmoa1902129

Cited by 150 publications

(152 citation statements)

References 29 publications

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“…Empirical evidence from the recent proof-of-concept study in Vietnam (Marks et al, 2019), together with historical evidence from the period of TB elimination in high-income countries, suggests that intensive active case finding alone may be sufficient to end TB, if sustained for a sufficient period and accompanied by concrete measures to address TB social determinants and health system failures. The place of treatment for LTBI in ending TB remains to be established.…”

Section: Discussionmentioning

confidence: 99%

“…Active case finding, in which people who are not actively seeking health care are sought out and screened for TB, regardless of symptoms, can overcome some of the limitations of passive case finding. Community-wide screening for active TB can be effective in reducing the prevalence of TB and TB infection, as shown recently in Vietnam (Marks et al, 2019). The results of these clinical trials need to be replicated in scaled up, programmatic situations through implementation and health system research.…”

Section: Diagnosing All Patients With Tbmentioning

confidence: 96%

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Ending tuberculosis by 2030—Pipe dream or reality?

Chakaya

Harries

Marks

2020

International Journal of Infectious Diseases

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Tuberculosis (TB) remains a major public health threat. In 2018, an estimated 10 million people fell ill with TB and 1.5 million died of the disease. The End TB Strategy envisages an end to TB as a public health threat and has set ambitious targets to reduce TB incidence and mortality by 90% and 95%, respectively, by 2035 compared with 2015. In this paper we describe the progress that is being made towards the achievement of these targets and highlight the challenges that are hampering this progress. The development and deployment of new tools will certainly accelerate progress towards ending TB. We believe that the end of TB is realizable if there are sustained efforts to actively find TB cases, a more robust multi-sectoral approach to tackle social determinants of TB, and improved person-centred health services.

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Section: Discussionmentioning

confidence: 99%

Section: Diagnosing All Patients With Tbmentioning

confidence: 96%

Ending tuberculosis by 2030—Pipe dream or reality?

Chakaya

Harries

Marks

2020

International Journal of Infectious Diseases

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“…Another five countries had TB budgets largely based on international funding, while the budget of 11 countries remained mostly unfunded [ 6 ]. Secondly, the perceived benefits and risks of ACF have been documented in the literature [ 12 , 31 – 35 ], while this study provides unique insights into NTP managers’ value judgements. The fact that all NTP managers agreed on the need for scaling up ACF seems important given that their leadership and commitment for ACF is considered paramount for ACF policy [ 11 ].…”

Section: Discussionmentioning

confidence: 95%

Active case-finding policy development, implementation and scale-up in high-burden countries: A mixed-methods survey with National Tuberculosis Programme managers and document review

et al. 2020

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Background The World Health Organization (WHO) stresses the importance of active case-finding (ACF) for early detection of tuberculosis (TB), especially in the 30 high-burden countries that account for almost 90% of cases globally. Objective To describe the attitudes of National TB Programme (NTP) managers related to ACF policy development, implementation and scale-up in the 30 high-burden countries, and to review national TB strategic plans. Methods This was a mixed-methods study with an embedded design: A cross-sectional survey with NTP managers yielded quantitative and qualitative data. A review of national TB strategic plans complemented the results. All data were analyzed in parallel and merged in the interpretation of the findings. Results 23 of the 30 NTP managers (77%) participated in the survey and 22 (73%) national TB strategic plans were reviewed. NTP managers considered managers in districts and regions key stakeholders for both ACF policy development and implementation. Different types of evidence were used to inform ACF policy, while there was a particular demand for local evidence. The NSPs reflected the NTP managers’ unanimous agreement on the need for ACF scale-up, but not all included explicit aims and targets related to ACF. The NTP managers recognized that ACF may decrease health systems costs in the long-term, while acknowledging the risk for increased health system costs in the short-term. About 90% of the NTP managers declared that financial and human resources were currently lacking, while they also elaborated on strategies to overcome resource constraints. Conclusion NTP managers stated that ACF should be scaled up but reported resource constraints. Strategies to increase resources exist but may not yet have been fully implemented, e.g. generating local evidence including from operational research for advocacy. Managers in districts and regions were identified as key stakeholders whose involvement could help improve ACF policy development, implementation and scale-up.

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“…Active case finding, in which people who do not actively seek health care are proactively sought out and screened for TB regardless of symptoms, has the potential to overcome some of these limitations. Some pilot projects have shown that community-wide screening for active TB can reduce TB prevalence and TB infection, as shown recently in Vietnam [9]. However, an evaluation of several active case finding projects in 16 countries showed no impact on national case notifications mainly because the projects had not been taken to scale due to costs and shortages of human resources [10].…”

Section: Screening and Diagnosismentioning

confidence: 99%

The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground

et al. 2020

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Ending the tuberculosis (TB) epidemic by 2030 requires two key actions: rapid diagnosis and effective treatment of active TB and identification and treatment of latent TB infection to prevent progression to active disease. We introduce this perspective by documenting the growing importance of TB preventive therapy on the international agenda coupled with global data showing poor implementation of preventive activities in programmatic settings. We follow this with two principal objectives. The first is to examine implementation challenges around diagnosis and treatment of active TB. Within this, we include recent evidence about the continued morbidity and heightened mortality that persists after TB treatment is successfully completed, thus elevating the importance of TB preventive therapy. The second objective is to outline how current TB preventive therapy activities have been shaped and are managed and propose how these can be improved through research and innovation. This includes expanding and giving higher priority to certain high-risk groups including those with fibrotic lung lesions on chest X-ray, showcasing the need to develop and deploy new biomarkers to more accurately predict risk of disease and making shorter treatment regimens, especially with rifapentine-isoniazid, more user-friendly and widely available. Ending the TB epidemic requires not only cure of the disease but preventing it before it even begins.

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Community-wide Screening for Tuberculosis in a High-Prevalence Setting

Cited by 150 publications

References 29 publications

Ending tuberculosis by 2030—Pipe dream or reality?

Ending tuberculosis by 2030—Pipe dream or reality?

Active case-finding policy development, implementation and scale-up in high-burden countries: A mixed-methods survey with National Tuberculosis Programme managers and document review

The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground

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