Screening of household contacts for TB infection in Cote d'Ivoire

Abstract

SETTING: Côte d'Ivoire is a country with a high incidence of TB. The control of TB infection is focused on high-risk patients but has limited implementation.OBJECTIVE: Cost-benefit analysis of TB infection (TBI) screening of household contacts in C??te d???Ivoire to evaluate economic implications of the implementation of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST).DESIGN: We compared the effectiveness of QuantiFERON-TB Gold Plus (QuantiFERON) with the TST using an economic model previously evaluated in medium TB incidence settings. Principal outcomes relating to TBI screening, as well as the lifetime costs and benefits of the patient cohort, were captured using a decision tree, followed by a Markov model.RESULTS: QuantiFERON proved to be both more effective and less costly than TST. Compared to QuantiFERON, TST use leads to an approximate 33% increase in the lifetime risk of developing active TB.CONCLUSIONS: For household contacts of active TB cases in C??te d???Ivoire, QuantiFERON is cost-effective when compared with TST. R shiny interactive interface enables model customisation for different scenarios, settings, risk groups and TBI screening methods. Further research should be conducted in similar settings to generalise the results.

Prevalence, Risk Factors, and Result Features in the Detection of Latent Tuberculosis Infection in Thai Healthcare Workers Using QuantiFERON-TB Gold Plus

“…Given the high background prevalence of TB in the country, the risk of TB infection among Thai HCWs is estimated to be high, higher than that in the community because they encounter a larger number of TB patients during their work, often under suboptimal prevention conditions due to limited resources or working constraints. For HCWs who work in environments with close, frequent, and prolonged exposure to infectious TB cases, the risk of infection is particularly increased [14]. The acquisition of TB infection in HCWs might also occur outside the hospital setting, such as in the community or through household contact.…”

“…Additionally, a high degree of correlation between IFN-γ concentrations in the TB1 and TB2 tubes was observed (Spearman's ρ=0.91; p-value < 0.05) (Figure 1). Generally, the QFT-Plus TB1 tube is quite similar to the QFT-GIT TB antigen tube except that the TB1 tube does not contain the TB7.7 antigenic peptide [14]. Both tubes contain long ESAT-6 and CFP-10 peptides, primarily stimulating CD4+ helper TB cells, while the antigenic peptides in the TB2 tube induce the CD8+ Tcell response.…”

“…Data on the prevalence and risk factors for LTBI are valuable as they can be used to design and implement effective interventions for TB infection prevention and control. Concurrently, the COVID-19 pandemic has affected TB services, including TB infection screening and prevention, impeding the progress of the End TB Strategy goals [14]. This study aimed to estimate the LTBI prevalence among Thai HCWs and assess risk factors associated with LTBI and the relationship with CD8+ T cell response according to QFT-Plus testing.…”