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Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial

Summary Background Control of tuberculosis in settings with high HIV prevalence is a pressing public health priority. We tested two active case-finding strategies to target long periods of infectiousness before diagnosis, which is typical of HIV-negative tuberculosis and is a key driver of transmiss... Full description

Journal Title: Lancet 2010, Vol.376 (9748), p.1244-1253
Main Author: Corbett, Elizabeth L, Dr
Other Authors: Bandason, Tsitsi, MSc , Duong, Trinh, MSc , Dauya, Ethel, BCom , Makamure, Beauty, BTech , Churchyard, Gavin J, Prof , Williams, Brian G, Prof , Munyati, Shungu S, MSc , Butterworth, Anthony E, Prof , Mason, Peter R, Prof , Mungofa, Stanley, MSc , Hayes, Richard J, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial
format: Article
creator:
  • Corbett, Elizabeth L, Dr
  • Bandason, Tsitsi, MSc
  • Duong, Trinh, MSc
  • Dauya, Ethel, BCom
  • Makamure, Beauty, BTech
  • Churchyard, Gavin J, Prof
  • Williams, Brian G, Prof
  • Munyati, Shungu S, MSc
  • Butterworth, Anthony E, Prof
  • Mason, Peter R, Prof
  • Mungofa, Stanley, MSc
  • Hayes, Richard J, Prof
subjects:
  • Adult
  • Bacterial diseases
  • Biological and medical sciences
  • Biomedical research
  • Cluster Analysis
  • Community Health Services - methods
  • Community Health Workers
  • Control
  • Diagnosis
  • Disease transmission
  • Fast track
  • Fast track — Articles
  • Female
  • General aspects
  • HIV Seropositivity - complications
  • HIV Seropositivity - epidemiology
  • Households
  • Human bacterial diseases
  • Human immunodeficiency virus
  • Humans
  • Infection control
  • Infectious diseases
  • Internal Medicine
  • Intervention
  • Male
  • Medical sciences
  • Methods
  • Microscopy, Fluorescence
  • Middle Aged
  • Miscellaneous
  • Mobile Health Units
  • Monitoring systems
  • Mycobacterium
  • Prevalence
  • Public health
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Risk factors
  • Sputum - microbiology
  • Studies
  • Tuberculosis
  • Tuberculosis and atypical mycobacterial infections
  • Tuberculosis, Pulmonary - diagnosis
  • Tuberculosis, Pulmonary - epidemiology
  • Tuberculosis, Pulmonary - prevention & control
  • Zimbabwe - epidemiology
ispartof: Lancet, 2010, Vol.376 (9748), p.1244-1253
description: Summary Background Control of tuberculosis in settings with high HIV prevalence is a pressing public health priority. We tested two active case-finding strategies to target long periods of infectiousness before diagnosis, which is typical of HIV-negative tuberculosis and is a key driver of transmission. Methods Clusters of neighbourhoods in the high-density residential suburbs of Harare, Zimbabwe, were randomised to receive six rounds of active case finding at 6-monthly intervals by either mobile van or door-to-door visits. Randomisation was done by selection of discs of two colours from an opaque bag, with one disc to represent every cluster, and one colour allocated to each intervention group before selection began. In both groups, adult (≥16 years) residents volunteering chronic cough (≥2 weeks) had two sputum specimens collected for fluorescence microscopy. Community health workers and cluster residents were not masked to intervention allocation, but investigators and laboratory staff were masked to allocation until final analysis. The primary outcome was the cumulative yield of smear-positive tuberculosis per 1000 adult residents, compared between intervention groups; analysis was by intention to treat. The secondary outcome was change in prevalence of culture-positive tuberculosis from before intervention to before round six of intervention in 12% of randomly selected households from the two intervention groups combined; analysis was based on participants who provided sputum in the two prevalence surveys. This trial is registered, number ISRCTN84352452. Findings 46 study clusters were identified and randomly allocated equally between intervention groups, with 55 741 adults in the mobile van group and 54 691 in the door-to-door group at baseline. HIV prevalence was 21% (1916/9060) and in the 6 months before intervention the smear-positive case notification rate was 2·8 per 1000 adults per year. The trial was completed as planned with no adverse events. The mobile van detected 255 smear-positive patients from 5466 participants submitting sputum compared with 137 of 4711 participants identified through door-to-door visits (adjusted risk ratio 1·48, 95% CI 1·11–1·96, p=0·0087). The overall prevalence of culture-positive tuberculosis declined from 6·5 per 1000 adults (95% CI 5·1–8·3) to 3·7 per 1000 adults (2·6–5·0; adjusted risk ratio 0·59, 95% CI 0·40–0·89, p=0·0112). Interpretation Wide implementation of active case finding, particularly with a mobile
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
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titleComparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial
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creatorCorbett, Elizabeth L, Dr ; Bandason, Tsitsi, MSc ; Duong, Trinh, MSc ; Dauya, Ethel, BCom ; Makamure, Beauty, BTech ; Churchyard, Gavin J, Prof ; Williams, Brian G, Prof ; Munyati, Shungu S, MSc ; Butterworth, Anthony E, Prof ; Mason, Peter R, Prof ; Mungofa, Stanley, MSc ; Hayes, Richard J, Prof
creatorcontribCorbett, Elizabeth L, Dr ; Bandason, Tsitsi, MSc ; Duong, Trinh, MSc ; Dauya, Ethel, BCom ; Makamure, Beauty, BTech ; Churchyard, Gavin J, Prof ; Williams, Brian G, Prof ; Munyati, Shungu S, MSc ; Butterworth, Anthony E, Prof ; Mason, Peter R, Prof ; Mungofa, Stanley, MSc ; Hayes, Richard J, Prof
descriptionSummary Background Control of tuberculosis in settings with high HIV prevalence is a pressing public health priority. We tested two active case-finding strategies to target long periods of infectiousness before diagnosis, which is typical of HIV-negative tuberculosis and is a key driver of transmission. Methods Clusters of neighbourhoods in the high-density residential suburbs of Harare, Zimbabwe, were randomised to receive six rounds of active case finding at 6-monthly intervals by either mobile van or door-to-door visits. Randomisation was done by selection of discs of two colours from an opaque bag, with one disc to represent every cluster, and one colour allocated to each intervention group before selection began. In both groups, adult (≥16 years) residents volunteering chronic cough (≥2 weeks) had two sputum specimens collected for fluorescence microscopy. Community health workers and cluster residents were not masked to intervention allocation, but investigators and laboratory staff were masked to allocation until final analysis. The primary outcome was the cumulative yield of smear-positive tuberculosis per 1000 adult residents, compared between intervention groups; analysis was by intention to treat. The secondary outcome was change in prevalence of culture-positive tuberculosis from before intervention to before round six of intervention in 12% of randomly selected households from the two intervention groups combined; analysis was based on participants who provided sputum in the two prevalence surveys. This trial is registered, number ISRCTN84352452. Findings 46 study clusters were identified and randomly allocated equally between intervention groups, with 55 741 adults in the mobile van group and 54 691 in the door-to-door group at baseline. HIV prevalence was 21% (1916/9060) and in the 6 months before intervention the smear-positive case notification rate was 2·8 per 1000 adults per year. The trial was completed as planned with no adverse events. The mobile van detected 255 smear-positive patients from 5466 participants submitting sputum compared with 137 of 4711 participants identified through door-to-door visits (adjusted risk ratio 1·48, 95% CI 1·11–1·96, p=0·0087). The overall prevalence of culture-positive tuberculosis declined from 6·5 per 1000 adults (95% CI 5·1–8·3) to 3·7 per 1000 adults (2·6–5·0; adjusted risk ratio 0·59, 95% CI 0·40–0·89, p=0·0112). Interpretation Wide implementation of active case finding, particularly with a mobile van approach, could have rapid effects on tuberculosis transmission and disease. Funding Wellcome Trust.
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subjectAdult ; Bacterial diseases ; Biological and medical sciences ; Biomedical research ; Cluster Analysis ; Community Health Services - methods ; Community Health Workers ; Control ; Diagnosis ; Disease transmission ; Fast track ; Fast track — Articles ; Female ; General aspects ; HIV Seropositivity - complications ; HIV Seropositivity - epidemiology ; Households ; Human bacterial diseases ; Human immunodeficiency virus ; Humans ; Infection control ; Infectious diseases ; Internal Medicine ; Intervention ; Male ; Medical sciences ; Methods ; Microscopy, Fluorescence ; Middle Aged ; Miscellaneous ; Mobile Health Units ; Monitoring systems ; Mycobacterium ; Prevalence ; Public health ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Risk factors ; Sputum - microbiology ; Studies ; Tuberculosis ; Tuberculosis and atypical mycobacterial infections ; Tuberculosis, Pulmonary - diagnosis ; Tuberculosis, Pulmonary - epidemiology ; Tuberculosis, Pulmonary - prevention & control ; Zimbabwe - epidemiology
ispartofLancet, 2010, Vol.376 (9748), p.1244-1253
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6Williams, Brian G, Prof
7Munyati, Shungu S, MSc
8Butterworth, Anthony E, Prof
9Mason, Peter R, Prof
10Mungofa, Stanley, MSc
11Hayes, Richard J, Prof
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0Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial
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descriptionSummary Background Control of tuberculosis in settings with high HIV prevalence is a pressing public health priority. We tested two active case-finding strategies to target long periods of infectiousness before diagnosis, which is typical of HIV-negative tuberculosis and is a key driver of transmission. Methods Clusters of neighbourhoods in the high-density residential suburbs of Harare, Zimbabwe, were randomised to receive six rounds of active case finding at 6-monthly intervals by either mobile van or door-to-door visits. Randomisation was done by selection of discs of two colours from an opaque bag, with one disc to represent every cluster, and one colour allocated to each intervention group before selection began. In both groups, adult (≥16 years) residents volunteering chronic cough (≥2 weeks) had two sputum specimens collected for fluorescence microscopy. Community health workers and cluster residents were not masked to intervention allocation, but investigators and laboratory staff were masked to allocation until final analysis. The primary outcome was the cumulative yield of smear-positive tuberculosis per 1000 adult residents, compared between intervention groups; analysis was by intention to treat. The secondary outcome was change in prevalence of culture-positive tuberculosis from before intervention to before round six of intervention in 12% of randomly selected households from the two intervention groups combined; analysis was based on participants who provided sputum in the two prevalence surveys. This trial is registered, number ISRCTN84352452. Findings 46 study clusters were identified and randomly allocated equally between intervention groups, with 55 741 adults in the mobile van group and 54 691 in the door-to-door group at baseline. HIV prevalence was 21% (1916/9060) and in the 6 months before intervention the smear-positive case notification rate was 2·8 per 1000 adults per year. The trial was completed as planned with no adverse events. The mobile van detected 255 smear-positive patients from 5466 participants submitting sputum compared with 137 of 4711 participants identified through door-to-door visits (adjusted risk ratio 1·48, 95% CI 1·11–1·96, p=0·0087). The overall prevalence of culture-positive tuberculosis declined from 6·5 per 1000 adults (95% CI 5·1–8·3) to 3·7 per 1000 adults (2·6–5·0; adjusted risk ratio 0·59, 95% CI 0·40–0·89, p=0·0112). Interpretation Wide implementation of active case finding, particularly with a mobile van approach, could have rapid effects on tuberculosis transmission and disease. Funding Wellcome Trust.
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titleComparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial
authorCorbett, Elizabeth L, Dr ; Bandason, Tsitsi, MSc ; Duong, Trinh, MSc ; Dauya, Ethel, BCom ; Makamure, Beauty, BTech ; Churchyard, Gavin J, Prof ; Williams, Brian G, Prof ; Munyati, Shungu S, MSc ; Butterworth, Anthony E, Prof ; Mason, Peter R, Prof ; Mungofa, Stanley, MSc ; Hayes, Richard J, Prof
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eissn1474-547X
codenLANCAO
abstractSummary Background Control of tuberculosis in settings with high HIV prevalence is a pressing public health priority. We tested two active case-finding strategies to target long periods of infectiousness before diagnosis, which is typical of HIV-negative tuberculosis and is a key driver of transmission. Methods Clusters of neighbourhoods in the high-density residential suburbs of Harare, Zimbabwe, were randomised to receive six rounds of active case finding at 6-monthly intervals by either mobile van or door-to-door visits. Randomisation was done by selection of discs of two colours from an opaque bag, with one disc to represent every cluster, and one colour allocated to each intervention group before selection began. In both groups, adult (≥16 years) residents volunteering chronic cough (≥2 weeks) had two sputum specimens collected for fluorescence microscopy. Community health workers and cluster residents were not masked to intervention allocation, but investigators and laboratory staff were masked to allocation until final analysis. The primary outcome was the cumulative yield of smear-positive tuberculosis per 1000 adult residents, compared between intervention groups; analysis was by intention to treat. The secondary outcome was change in prevalence of culture-positive tuberculosis from before intervention to before round six of intervention in 12% of randomly selected households from the two intervention groups combined; analysis was based on participants who provided sputum in the two prevalence surveys. This trial is registered, number ISRCTN84352452. Findings 46 study clusters were identified and randomly allocated equally between intervention groups, with 55 741 adults in the mobile van group and 54 691 in the door-to-door group at baseline. HIV prevalence was 21% (1916/9060) and in the 6 months before intervention the smear-positive case notification rate was 2·8 per 1000 adults per year. The trial was completed as planned with no adverse events. The mobile van detected 255 smear-positive patients from 5466 participants submitting sputum compared with 137 of 4711 participants identified through door-to-door visits (adjusted risk ratio 1·48, 95% CI 1·11–1·96, p=0·0087). The overall prevalence of culture-positive tuberculosis declined from 6·5 per 1000 adults (95% CI 5·1–8·3) to 3·7 per 1000 adults (2·6–5·0; adjusted risk ratio 0·59, 95% CI 0·40–0·89, p=0·0112). Interpretation Wide implementation of active case finding, particularly with a mobile van approach, could have rapid effects on tuberculosis transmission and disease. Funding Wellcome Trust.
copKidlington
pubElsevier Ltd
pmid20923715
doi10.1016/S0140-6736(10)61425-0
oafree_for_read