Yield of Facility-based Targeted Universal Testing for Tuberculosis With Xpert and Mycobacterial Culture in High-Risk Groups Attending Primary Care Facilities in South Africa

Abstract Background We report the yield of targeted universal tuberculosis (TB) testing of clinic attendees in high-risk groups. Methods Clinic attendees in primary healthcare facilities in South Africa with one of the following risk factors underwent sputum testing for TB: human immunodeficiency vi...

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Bibliographic Details
Published in:Clinical infectious diseases 2023-05, Vol.76 (9), p.1594-1603
Main Authors: Berhanu, Rebecca H, Lebina, Limakatso, Nonyane, Bareng A S, Milovanovic, Minja, Kinghorn, Anthony, Connell, Lucy, Nyathi, Sipho, Young, Katherine, Hausler, Harry, Naidoo, Pren, Brey, Zameer, Shearer, Kate, Genade, Leisha, Martinson, Neil A
Format: Article
Language:English
Subjects:
Adult
Female
HIV
HIV Infections - complications
HIV Infections - epidemiology
Humans
Major
Male
Mycobacterium tuberculosis - genetics
Primary Health Care
Sensitivity and Specificity
South Africa - epidemiology
Sputum - microbiology
Tuberculosis - diagnosis
Tuberculosis - epidemiology
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Summary:Abstract Background We report the yield of targeted universal tuberculosis (TB) testing of clinic attendees in high-risk groups. Methods Clinic attendees in primary healthcare facilities in South Africa with one of the following risk factors underwent sputum testing for TB: human immunodeficiency virus (HIV), contact with a TB patient in the past year, and having had TB in the past 2 years. A single sample was collected for Xpert-Ultra (Xpert) and culture. We report the proportion positive for Mycobacterium tuberculosis. Data were analyzed descriptively. The unadjusted clinical and demographic factors’ relative risk of TB detected by culture or Xpert were calculated and concordance between Xpert and culture is described. Results A total of 30 513 participants had a TB test result. Median age was 39 years, and 11 553 (38%) were men. The majority (n = 21734, 71%) had HIV, 12 492 (41%) reported close contact with a TB patient, and 1573 (5%) reported prior TB. Overall, 8.3% were positive for M. tuberculosis by culture and/or Xpert compared with 6.0% with trace-positive results excluded. In asymptomatic participants, the yield was 6.7% and 10.1% in symptomatic participants (with trace-positives excluded). Only 10% of trace-positive results were culture-positive. We found that 55% of clinic attendees with a sputum result positive for M. tuberculosis did not have a positive TB symptom screen. Conclusions A high proportion of clinic attendees with specific risk factors (HIV, close TB contact, history of TB) test positive for M. tuberculosis when universal testing is implemented. Clinic attendees in South Africa at high risk for tuberculosis (TB) living with human immunodeficiency virus, having close contact with a TB patient, or with a prior history of TB underwent universal sputum testing irrespective of the presence of TB symptoms. A high proportion (6%) had a positive test for TB.
ISSN:1058-4838
1537-6591
1537-6591
DOI:10.1093/cid/ciac965