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Modelling the impact of chest X-ray and alternative triage approaches prior to seeking a tuberculosis diagnosis

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Rahman, A A M Shazzadur, Langley, Ivor ORCID: https://orcid.org/0000-0002-9275-6731, Galliez, Rafael, Kritski, Afranio, Tomeny, Ewan ORCID: https://orcid.org/0000-0003-4547-2389 and Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2019) 'Modelling the impact of chest X-ray and alternative triage approaches prior to seeking a tuberculosis diagnosis'. BMC Infectious Diseases, Vol 19, e93.

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Abstract

Background

Tuberculosis is a major challenge to health in the developing world. Triage prior to diagnostic testing could potentially reduce the volume of tests and costs associated with using the more accurate, but costly, Xpert MTB/RIF assay. An effective methodology to predict the impact of introducing triage prior to tuberculosis diagnostic testing could be useful in helping to guide policy.
Methods
The development and use of operational modelling to project the impact on case detection and health system costs of alternative triage approaches for tuberculosis, with or without X-ray, based on data from Porto Alegre City, Brazil.
Results
Most of the triage approaches modelled without X-ray were predicted to provide no significant benefit. One approach based on an artificial neural network applied to patient and symptom characteristics was projected to increase case detection (82% vs. 75%) compared to microscopy, and reduce costs compared to Xpert without triage. In addition, use of X-ray before diagnostic testing for HIV-negative patients could maintain diagnostic yield of using Xpert without triage, and reduce costs.
Conclusion
A model for the impact assessment of alternative triage approaches has been tested. The results from using the approach demonstrate its usefulness in informing policy in a typical high burden setting for tuberculosis.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
WF Respiratory System > Lungs > WF 600 Lungs
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12879-019-3684-1
Depositing User: Stacy Murtagh
Date Deposited: 31 Jan 2019 19:25
Last Modified: 01 Feb 2019 15:50
URI: http://archive.lstmed.ac.uk/id/eprint/9988

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