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Burke, Rachael M, Nliwasa, Marriott, Dodd, Peter J, Feasey, Helena R, Khundi, McEwen, Choko, Augustine, Nzawa-Soko, Rebecca, Mpunga, James, Webb, Emily L, Fielding, Katherine, MacPherson, Peter and Corbett, Elizabeth L (2023) 'Impact of community-wide tuberculosis active case finding and HIV testing on tuberculosis trends in Malawi.'. Clinical Infectious Diseases, Vol 77, Issue 1, pp. 94-100.
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Abstract
BACKGROUND
Tuberculosis case-finding interventions are critical to meeting World Health Organization End TB strategy goals. We investigated the impact of community-wide tuberculosis active case-finding (ACF) alongside scale-up of HIV testing and care on trends in adult tuberculosis case notification rates (CNRs) in Blantyre, Malawi.
METHODS
Five rounds of ACF for tuberculosis (1-2 weeks of leafleting, door-to-door enquiry for cough and sputum microscopy) were delivered to neighbourhoods ("ACF areas") in North-West Blantyre between April 2011 and August 2014. Many of these neighborhoods also had concurrent HIV testing interventions. The remaining neighbourhoods in Blantyre City ("non-ACF areas") provided a non-randomised comparator. We analyzed TB CNRs from January 2009 until December 2018. We used interrupted time series analysis to compare tuberculosis CNRs before ACF and after ACF, and between ACF and non-ACF areas.
FINDINGS
Tuberculosis CNRs increased in Blantyre concurrently with start of ACF for tuberculosis in both ACF and non-ACF areas, with a larger magnitude in ACF areas. Compared to a counterfactual where pre-ACF CNR trends continued during ACF period, we estimated there were an additional 101 (95% confidence interval [CI] 42 to 160) microbiologically confirmed (Bac+) tuberculosis diagnoses per 100,000 person-years in the ACF areas in three and a half years of ACF. Compared to a counterfactual where trends in ACF area were the same as trends in non-ACF areas, we estimated an additional 63 (95% CI 38 to 90) Bac+ diagnoses per 100,000 person-years in the same period.
INTERPRETATION
Tuberculosis ACF was associated with a rapid increase in people diagnosed with tuberculosis in Blantyre.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | NOT_LSTM |
| Subjects: | WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis |
| Faculty: Department: | Clinical Sciences & International Health > International Public Health Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1093/cid/ciad238 |
| Depositing User: | Rachel Dominguez |
| Date Deposited: | 05 Jul 2023 10:52 |
| Last Modified: | 05 Jul 2023 10:52 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/22760 |
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