Abstract
Background: Assessment of the effectiveness of tuberculosis control strategies requires the periodic measurement of M. tuberculosis transmission in populations, which is notoriously difficult. One well-established method is to measure the prevalence of infectious pulmonary tuberculosis in the population which is then repeated at a second time point after a period of 'intervention', such as scale up of the Search-Treat-Prevent strategy of the Zero TB Cities initiative, allowing for a 'before and after' comparison. Protocol: The concurrent adult pulmonary tuberculosis prevalence survey (using digital radiography and Xpert MTB/RIF Ultra) and child M. tuberculosis infection survey (using QuantiFERON-TB® Gold Plus) will primarily provide a baseline measure of the burden of adult infectious tuberculosis in Karachi and assess whether a large-scale interferon gamma release assay survey in children aged 2 to 4 years is feasible. The target population for the prevalence survey is comprised of a stratified random sample of all adults aged 15 years and above and all children aged 2 to 4 years resident in four districts in Karachi. The survey procedures and analyses to estimate pulmonary tuberculosis prevalence are based on the World Health Organization methodology for tuberculosis prevalence surveys. Ethics and dissemination: The study protocol has been approved by the Interactive Research Development / The Indus Hospital Research Centre Research Ethics Committee in Karachi, Pakistan and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Due to non-representative sampling in this setting, where a large proportion of the population are illiterate and are reluctant to provide fingerprints due to concerns about personal security, verbal informed consent will be obtained from each eligible participant or guardian. Results will be submitted to international peer-reviewed journals, presented at international conferences and shared with participating communities and with the Provincial and National TB programme.
Highlights
Current strategies are failing to contain the global tuberculosis epidemic, and are far from achieving the sustained reductions in tuberculosis disease incidence of up to 17% per year which are required to meet the targets set out in the World Health Organization (WHO) End TB Strategy by 20351
The survey procedures and analyses to estimate pulmonary tuberculosis prevalence are based on the World Health Organization methodology for tuberculosis prevalence surveys
Ethics and dissemination: The study protocol has been approved by the Interactive Research Development / The Indus Hospital Research Centre Research Ethics Committee in Karachi, Pakistan and the London School of Hygiene & Tropical Medicine Research Ethics Committee
Summary
Current strategies are failing to contain the global tuberculosis epidemic, and are far from achieving the sustained reductions in tuberculosis disease incidence of up to 17% per year which are required to meet the targets set out in the World Health Organization (WHO) End TB Strategy by 20351. The aim of the initiative is to create “islands of tuberculosis elimination” through (i) active case-finding (ACF) using systematic and evidence-based diagnostic algorithms (‘search’), (ii) early and effective treatment (‘treat’) and (iii) a reduction in M. tuberculosis exposure through infection prevention and control in healthcare facilities including ultraviolet germicidal irradiation and provision of preventive therapy for high risk groups (‘prevent’)[2] This ‘Search-Treat-Prevent’ strategy has been adopted by key stakeholders including the Stop TB Partnership and a number of non-governmental organisations - Partners in Health, Advance Access & Delivery, Interactive Research and Development (IRD), underpinned by academic input from the Centre for Global Health Delivery-Dubai, Harvard Medical School, in a number of cities, namely Chennai, Lima and Karachi[3]. If the child IGRA survey is feasible the plan would be to repeat the IGRA survey as part of the end line survey in 2022–2023 in children aged 2 to 8 years stratified by those born after the implementation of Zero TB (children aged 2 to 4 years) and those born before/during early implementation of the Zero TB initiative (children aged 5 to 8 years)
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