Symptom and digital chest X-ray TB screening in South African prisons: yield and cost-effectiveness

Kim, H. Y.; Zishiri, Vincent; Page-Shipp, Liesl; Makgopa, Sylvia; Churchyard, Gavin J.; Dowdy, David W.; Charalambous, Salome; Hoffmann, Christopher J.

doi:10.5588/ijtld.19.0214

Cited by 5 publications

(3 citation statements)

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“…This finding however provides insight into the innovations that may lead to the achievement of the 90% TB detection for the END TB strategy [3]. The Tuberculosis Research and Treatment results are also in agreement with a study done in South Africa on symptoms and digital CXR screening which recorded improvement in the yield of TB [26] screening among prisoners when both screening strategies were employed. The addition of the CXR to symptoms in screening TB can be employed to identify potential TB cases that would be missed when using only symptoms for screening.…”

Section: Discussionsupporting

confidence: 85%

Accuracy and Incremental Yield of the Chest X-Ray in Screening for Tuberculosis in Uganda: A Cross-Sectional Study

Nalunjogi

Mugabe

Najjingo

et al. 2021

Tuberculosis Research and Treatment

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The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be suboptimal since up to 44% of individuals with TB are asymptomatic. The chest X-ray (CXR) as a screening tool for pulmonary TB was evaluated in this study, as well as its incremental yield in TB diagnosis using a cross-sectional study involving secondary analysis of data of 4512 consented/assented participants ≥15 years who participated in the Uganda National TB prevalence survey between 2014 and 2015. Participants with a cough ≥2 weeks, fever, weight loss, and night sweats screened positive for TB using the symptoms screening method, while participants with a TB defining abnormality on CXR screened positive for TB by the CXR screening method. The Löwenstein-Jensen (LJ) culture was used as a gold standard for TB diagnosis. The CXR had 93% sensitivity and 65% specificity compared to LJ culture results, while symptoms had 76% sensitivity and 31% specificity. The screening algorithm involving the CXR in addition to symptoms led to a 38% increment in the yield of diagnosed tuberculosis. The number needed to screen using the CXR and symptoms screening algorithm was 32 compared to 45 when the symptoms are used alone. Therefore, the CXR in combination with symptoms is a good TB screening tool and increases the yield of diagnosed TB.

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Section: Discussionsupporting

confidence: 85%

Accuracy and Incremental Yield of the Chest X-Ray in Screening for Tuberculosis in Uganda: A Cross-Sectional Study

Nalunjogi

Mugabe

Najjingo

et al. 2021

Tuberculosis Research and Treatment

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“…This initiative did not report its case detection yields disaggregated by symptom status, as only computer-aided reading (CAR) software interpretations of CXR images were used to indicate follow-on diagnostic testing. Several other small-scale studies have also used CXR screening among key populations, including household contacts [15,16] and inmates [17,18], and have reported the detection of high proportions of sub-clinical and low-grade TB.…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

Nguyen

Codlin²,

Vo³

et al. 2020

TropicalMed

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Across Asia, a large proportion of people with tuberculosis (TB) do not report symptoms, have mild symptoms or only experience symptoms for a short duration. These individuals may not seek care at health facilities or may be missed by symptom screening, resulting in sustained TB transmission in the community. We evaluated the yields of TB from 114 days of community-based, mobile chest X-ray (CXR) screening. The yields at each step of the TB screening cascade were tabulated and we compared cohorts of participants who reported having a prolonged cough and those reporting no cough or one of short duration. We estimated the marginal yields of TB using different diagnostic algorithms and calculated the relative diagnostic costs and cost per case for each algorithm. A total of 34,529 participants were screened by CXR, detecting 256 people with Xpert-positive TB. Only 50% of those diagnosed with TB were detected among participants reporting a prolonged cough. The study’s screening algorithm detected almost 4 times as much TB as the National TB Program’s standard diagnostic algorithm. Community-based, mobile chest X-ray screening can be a high yielding strategy which is able to identify people with TB who would likely otherwise have been missed by existing health services.

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“…Additionally, one study first screened prisoners with four-symptom screening, but rather than only using CXR on symptom-positive individuals, CXR was performed BMJ Public Health on every individual being screened, significantly driving up costs. 32 Importantly, the combination in which tests are used matters, for example, CXR as a screening tool followed by SSM as diagnostic was found to be more cost-effective than SSM (negative) followed by CXR. 33 Furthermore, screening techniques using TB-LAM are more cost-effective than GeneXpert for TB screening.…”

Section: Cost-effectiveness Of Screening For Tb Diseasementioning

confidence: 98%

Cost-effectiveness of diagnostic tools and strategies for the screening and diagnosis of tuberculosis disease and infection: a scoping review

Ockhuisen,

de Nooy,

Jenkins

et al. 2024

bmjph

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The objective of this scoping review is to understand the cost-effectiveness of current and future tools/strategies for screening and diagnosis of tuberculosis (TB) infection and disease. To this end, PubMed, EMBASE and SCOPUS were used to identify any English language reports on the cost-effectiveness of TB infection/disease screening/diagnostic strategies published between 1 January 2017 and 7 October 2023. Studies included high-burden/risk TB populations, compared diagnostic/screening methods and conducted a cost-effectiveness/economic evaluation. We stratified the included articles in four groups (cost-effectiveness of diagnosing TB disease/infection and cost-effectiveness of screening for TB disease/infection). A full-text review was conducted, and relevant costing data extracted. Of the 2417 articles identified in the initial search, 112 duplicates were removed, and 2305 articles were screened for title and abstract. 23 full articles were reviewed, and 17 fulfilled all inclusion criteria. While sputum smear microscopy (SSM) has been the primary method of diagnosing TB disease in high-burden countries, the current body of literature suggests that SSM is likely to be the least cost-effective tool for the diagnosis of TB disease. Further scale-up with molecular diagnostics, such as GeneXpert and Truenat, was shown to be broadly cost-effective, with a multitest approach likely to be cost-effective for both screening and diagnosis. There is an urgent need to increase access and remove barriers to implementation of diagnostics that have been repeatedly shown to be cost-effective, as well as to develop new diagnostic and screening technologies/strategies to address current barriers to scale-up.

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Symptom and digital chest X-ray TB screening in South African prisons: yield and cost-effectiveness

Cited by 5 publications

References 0 publications

Accuracy and Incremental Yield of the Chest X-Ray in Screening for Tuberculosis in Uganda: A Cross-Sectional Study

Accuracy and Incremental Yield of the Chest X-Ray in Screening for Tuberculosis in Uganda: A Cross-Sectional Study

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

Cost-effectiveness of diagnostic tools and strategies for the screening and diagnosis of tuberculosis disease and infection: a scoping review

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