Pooling of sputum samples to increase tuberculosis diagnostic capacity in Brazil during the COVID-19 pandemic

Santos, Victor Santana; Allgayer, Manuela Filter; Kontogianni, Konstantina; Rocha, José Erinaldo; Pimentel, Beatriz Jatobá; Amorim, Maria Telma Pinheiro; Duarte, Morgana Valnia Simões Cavalcanti; Ferreira, Polyanne de Melo; Moura, Luciana Coelho Leite; Lima, Victoria Paulino Santos de; Guimarães, Larissa Cândido; Dodd, James; Creswell, Jacob; Cuevas, Luis E.

doi:10.1016/j.ijid.2023.01.009

Cited by 8 publications

(2 citation statements)

References 8 publications

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“…The clear gradient of Xpert positivity by threshold scores potentially provides an additional way to save Xpert cartridge costs. During the Covid-19 pandemic, several studies demonstrated the promise of pooling sputum to reduce the number of tests and time needed to diagnose someone with TB (35,36,37). Using the abnormality score could help further reduce testing requirements if, for example, those with scores above .70 were tested individually, but lower scores were pooled since the positivity rates were much lower.…”

Section: Discussionmentioning

confidence: 99%

Results from TB screening using ultraportable x-ray and artificial intelligence in remote populations in northeast Nigeria

John

Abdulkarim²,

Usman

et al. 2023

Preprint

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Background: Ultraportable X-ray devices coupled with artificial intelligence (AI) are beginning to be used widely to screen for TB in remote settings. Few studies have documented their performance. Methods: We organized screening camps in Gombe and Adamawa states of Northeast Nigeria using a team of a registration officer, data entry staff, a radiographer, and a coordination officer. All consenting individuals ≥ 15 years were screened for TB symptoms (cough, fever, night sweats, and weight loss) and received a CXR. We used a MinXray Impact system interpreted by AI (qXR V3), which is a fully integrated wireless setup, can be run without electricity, and weighs approximately 30kg. We collected sputum samples from individuals with an abnormality score of .30 or higher or if they reported any TB symptoms. Samples were transported for testing with Xpert MTB/RIF. We documented the TB screening cascade and evaluated the performance of screening with different combinations of CXR read by AI and symptoms. Results: We screened 5,298 individuals during 66 camps; 2,685 (51%) were females, and 2,613 (49%) were males. Using ≥ 2 weeks of cough to define presumptive TB, 1,056 people (20%) would be identified. If a cough of any duration was used, the number with presumptive TB increased to 1,889 (36%) and to 3,084 (58%) if any of the four symptoms were used. Overall, 770 (14.5%) had abnormality scores of 0.3 or higher, and 447 (8.4%) had a score of 0.5 or higher. We collected 1,022 samples for Xpert testing and detected 85 (8%) individuals with TB. Traditional symptom screening of prolonged cough only identified 40% of people with TB, while using any symptom detected 90.6% of people with TB, but specificity was 11.4%. Using an AI abnormality score of .50, only used 424 tests to identify 89.4% of people with TB with a specificity of 62.8%. Conclusion: Ultra-portable CXR can be used to provide better TB screening in hard-to-reach areas. Symptom screening may miss large proportions of people with bacteriologically confirmed TB. Employing AI to read CXR can improve triaging when human readers are unavailable and can save expensive diagnostic testing costs.

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Section: Discussionmentioning

confidence: 99%

Results from TB screening using ultraportable x-ray and artificial intelligence in remote populations in northeast Nigeria

John

Abdulkarim²,

Usman

et al. 2023

Preprint

Self Cite

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“…Nineteen publications [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] focused on COVID-19's detrimental impacts on TB diagnosis, laboratory capacity and systems, and the supply chain.…”

Section: Diagnosis and Laboratory Systemsmentioning

confidence: 99%

The Global Impact of COVID-19 on Tuberculosis: A Thematic Scoping Review, 2020-2023

Marco,

Ahmedov,

Castro

2024

Preprint

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Background: This thematic scoping review of publications sought to understand the global impact of COVID-19 on tuberculosis (TB), interpret the scope of resonating themes, and offer policy recommendations to stimulate TB recovery and future pandemic preparedness. Data Sources: Publications were captured from three search engines, PubMed, EBSCO, and Google Scholar, and applicable websites written in English from January 1, 2020, to April 30, 2023. Study Selection: Our scoping review was limited to publications detailing the impact of COVID-19 on TB. Original research, reviews, letters, and editorials describing the deleterious and harmful––yet sometimes positive–– impact of COVID-19 (sole exposure) on TB (sole outcome) were included. The objective was to methodically categorize the impacts into themes through a comprehensive review of selected studies to provide significant health policy guidance. Data Extraction: Two authors independently screened citations and full texts, while the third arbitrated when consensus was not met. All three performed data extraction. Data Synthesis/Results: Of 1,755 screened publications, 176 (10%) covering 39 countries over 41 months met the inclusion criteria. Ten principal themes were established, which encompassed TB’s care cascade, patient-centered care, psychosocial issues, and health services: 1) case-finding and notification (n=45; 26%); 2) diagnosis and laboratory systems (n=19; 10.7%) 3) prevention, treatment, and care (n=22; 12.2%); 4) telemedicine/telehealth (n=12; 6.8%); 5) social determinants of health (n=14; 8%); 6) airborne infection prevention and control (n=8; 4.6%); 7) health system strengthening (n=22; 13%); 8) mental health (n=13; 7.4%); 9) stigma (n=11; 6.3%); and 10) health education (n=10; 5.7%). Limitations: Heterogeneity of publications within themes. Conclusions: We identified ten globally generalizable themes of COVID-19’s impact on TB. These thematic areas will guide evidence-informed policies to strengthen comprehensive global responses, recovery for TB, and future airborne pandemic preparedness.

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Pooling sputum samples for the Xpert MTB/RIF Ultra assay: A sensitive and effective screening strategy

Quan,

Qiu,

et al. 2024

Tuberculosis

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Pooling of sputum samples to increase tuberculosis diagnostic capacity in Brazil during the COVID-19 pandemic

Cited by 8 publications

References 8 publications

Results from TB screening using ultraportable x-ray and artificial intelligence in remote populations in northeast Nigeria

Results from TB screening using ultraportable x-ray and artificial intelligence in remote populations in northeast Nigeria

The Global Impact of COVID-19 on Tuberculosis: A Thematic Scoping Review, 2020-2023

Pooling sputum samples for the Xpert MTB/RIF Ultra assay: A sensitive and effective screening strategy

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