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  • OA-208 Evaluating the impact of computer-assisted x-ray diagnosis and other triage tools to optimise Xpert orientated community-based active case finding for TB and COVID-19 (XACT-19)

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OA-208 Evaluating the impact of computer-assisted x-ray diagnosis and other triage tools to optimise Xpert orientated community-based active case finding for TB and COVID-19 (XACT-19)
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  1. Alex Scott1,2,
  2. Mohammed Limbada3,
  3. Tahlia Perumal1,2,
  4. Shameem Jaumdally1,2,
  5. Anil Pooran1,2,
  6. Andrea Kotze1,2,
  7. Charnay Van der Merwe1,2,
  8. Maina Cheeba3,
  9. Deborah Milimo3,
  10. Suzette Oelofse1,2,
  11. Aliasgar Esmail1,2,
  12. Helen Ayles3,4,
  13. Keertan Dheda1,2,5,6
  1. 1Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, South Africa
  2. 2South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, South Africa
  3. 3Zambart, University of Zambia, Zambia
  4. 4Department of Clinical Research, London School of Hygiene and Tropical Medicine, UK
  5. 5Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
  6. 6Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, UK

Abstract

Background Almost 40% of persons newly diagnosed with TB are unreported. Detecting cases in TB/HIV endemic communities have been restricted by a lack of sensitive and user-friendly point-of-care (POC) diagnostic tools. Computer-aided detection (CAD) has been recommended by the WHO for screening for TB, however, implementation of CAD in community-based active case finding (ACF) is unclear. We aimed determine the adjunctive role of CAD in Xpert-orientated community-based ACF for TB.

Methods In this ongoing, EDCTP-funded (RIA2020S-3295), open-labelled randomised controlled trial (RCT), high-risk persons (symptomatic and/or HIV-infected) with presumed TB were recruited from TB/HIV endemic communities in South Africa and Zambia (Zimbabwe is an additional site). Using a low-cost mobile van staffed by three healthcare workers and equipped with an ultra-portable x-ray and GeneXpert® system, participants were randomized into either ‘CAD + POC Xpert’ (Arm 1: CAD followed by Xpert MTB/RIF Ultra in CAD-positive participants using a CAD4TB v7 threshold of 10 [South Africa] and 50 [Zambia] based on prior population-specific calibration), or ‘POC Xpert alone’ (Arm 2: POC Xpert MTB/RIF Ultra only). The primary outcome was time to detection of microbiologically proven TB (Xpert and/or culture positivity). Here we present an interim trial progress report.

Results From Feb 2022, a total of 505 participants have been enrolled (256 [50.7%] from South Africa and 249 [49.3%] from Zambia). 26.9% (136/505) of participants were HIV-infected (median CD4 of 609). 33/505 (6.5%) tested positive for TB (25/256 [9.8%] in South Africa and 8/249 [3.2%] in Zambia). 15 participants underwent screening to detect 1 case of TB. Of TB-positive participants, 7/33 (21.2%) were smear positive.

Conclusion Community-based ACF detected a high burden of TB, of which a significant minority (~20%) was probably infectious. These data have implications for ACF strategies in high burden settings.

https://doi.org/10.1136/bmjgh-2023-EDC.16

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