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

    International journal of infectious diseases, 08/2024, Letnik: 145
    Journal Article

    •Community-based integration of TB and COVID-19 screening is feasible.•Point-of-care molecular and radiological screening tools have high diagnostic yield.•This active case-finding strategy detects individuals with probably infectious TB. 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). 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. 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. 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.