Integrating molecular and radiological screening tools during community-based active case-finding for tuberculosis and COVID-19 in southern Africa

Alex John Scott; Mohammed Limbada; Tahlia Perumal; Shameem Jaumdally; Andrea Kotze; Charnay van der Merwe; Maina Cheeba; Deborah Milimo; Keelin Murphy; Bram van Ginneken; Mariana de Kock; Robin Mark Warren; Phindile Gina; Jeremi Swanepoel; Louié Kühn; Suzette Oelofse; Anil Pooran; Aliasgar Esmail; Helen Ayles; Keertan Dheda

doi:10.1016/j.ijid.2024.107081

Integrating molecular and radiological screening tools during community-based active case-finding for tuberculosis and COVID-19 in southern Africa

Int J Infect Dis. 2024 May 1:145:107081. doi: 10.1016/j.ijid.2024.107081. Online ahead of print.

Authors

Alex John Scott¹, Mohammed Limbada², Tahlia Perumal¹, Shameem Jaumdally¹, Andrea Kotze¹, Charnay van der Merwe¹, Maina Cheeba², Deborah Milimo², Keelin Murphy³, Bram van Ginneken³, Mariana de Kock⁴, Robin Mark Warren⁴, Phindile Gina¹, Jeremi Swanepoel¹, Louié Kühn¹, Suzette Oelofse¹, Anil Pooran¹, Aliasgar Esmail¹, Helen Ayles⁵, Keertan Dheda⁶

Affiliations

¹ Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, Cape Town, South Africa; South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.
² Zambart, University of Zambia, Lusaka, Zambia.
³ Radboud University Medical Center, Nijmegen, the Netherlands.
⁴ DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa.
⁵ Zambart, University of Zambia, Lusaka, Zambia; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁶ Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, Cape Town, South Africa; South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa; Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: keertan.dheda@uct.ac.za.

PMID: 38701914
DOI: 10.1016/j.ijid.2024.107081

Abstract

Objectives: To evaluate diagnostic yield and feasibility of integrating testing for TB and COVID-19 using molecular and radiological screening tools during community-based active case-finding (ACF).

Methods: Community-based participants with presumed TB and/or COVID-19 were recruited using a mobile clinic. Participants underwent simultaneous point-of-care (POC) testing for TB (sputum; Xpert Ultra) and COVID-19 (nasopharyngeal swabs; Xpert SARS-CoV-2). Sputum culture and SARS-CoV-2 RT-PCR served as reference standards. Participants underwent ultra-portable POC chest radiography with computer-aided detection (CAD). TB infectiousness was evaluated using smear microscopy, cough aerosol sampling studies (CASS), and chest radiographic cavity detection. Feasibility of POC testing was evaluated via user-appraisals.

Results: Six hundred and one participants were enrolled, with 144/601 (24.0%) reporting symptoms suggestive of TB and/or COVID-19. 16/144 (11.1%) participants tested positive for TB, while 10/144 (6.9%) tested positive for COVID-19 (2/144 [1.4%] had concurrent TB/COVID-19). Seven (7/16 [43.8%]) individuals with TB were probably infectious. Test-specific sensitivity and specificity (95% CI) were: Xpert Ultra 75.0% (42.8-94.5) and 96.9% (92.4-99.2); Xpert SARS-CoV-2 66.7% (22.3-95.7) and 97.1% (92.7-99.2). Area under the curve (AUC) for CAD4TB was 0.90 (0.82-0.97). User appraisals indicated POC Xpert to have 'good' user-friendliness.

Conclusions: Integrating TB/COVID-19 screening during community-based ACF using POC molecular and radiological tools is feasible, has a high diagnostic yield, and can identity probably infectious persons.

Keywords: COVID-19; Community-based active case-finding; Diagnostics; Feasibility; Integration; Tuberculosis.