Abstract
The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be suboptimal since up to 44% of individuals with TB are asymptomatic. The chest X-ray (CXR) as a screening tool for pulmonary TB was evaluated in this study, as well as its incremental yield in TB diagnosis using a cross-sectional study involving secondary analysis of data of 4512 consented/assented participants ≥15 years who participated in the Uganda National TB prevalence survey between 2014 and 2015. Participants with a cough ≥2 weeks, fever, weight loss, and night sweats screened positive for TB using the symptoms screening method, while participants with a TB defining abnormality on CXR screened positive for TB by the CXR screening method. The Löwenstein-Jensen (LJ) culture was used as a gold standard for TB diagnosis. The CXR had 93% sensitivity and 65% specificity compared to LJ culture results, while symptoms had 76% sensitivity and 31% specificity. The screening algorithm involving the CXR in addition to symptoms led to a 38% increment in the yield of diagnosed tuberculosis. The number needed to screen using the CXR and symptoms screening algorithm was 32 compared to 45 when the symptoms are used alone. Therefore, the CXR in combination with symptoms is a good TB screening tool and increases the yield of diagnosed TB.
Highlights
The WHO 2020 estimates show that tuberculosis (TB) was responsible for 1.4 million deaths [1]
We excluded 36,012 records of participants who screened negative on the chest X-ray (CXR) and symptoms and were not required to submit sputum for TB diagnosis. 630 records that were missing data on culture results were excluded leaving 4512 records for further analysis as shown below (Figure 1)
This study compared the accuracy of the CXR or symptoms against culture-confirmed pulmonary TB by the Lowenstein Jensen (LJ) method in a community TB screening setting such as the National TB prevalence survey
Summary
The WHO 2020 estimates show that tuberculosis (TB) was responsible for 1.4 million deaths [1]. In order to combat tuberculosis, WHO proposed three strategies including intensified case finding (ICF), isoniazid preventive therapy (IPT), and infection control (IC) [2]. The WHO END TB strategy indicates a need for ≥90% TB case detection among others to combat TB [3]. Uganda has a high TB incidence of 201 per 100,000 population as well as high TB-related mortality of 26 per 100,000 population with a TB case detection rate of 72% [4]. The strategic plan for the Uganda national TB and leprosy programme (NTLP) sought to achieve 85% case detection by 2019/2020; confirming TB was difficult. There is a need to explore more widely available, low-cost screening and Tuberculosis Research and Treatment
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