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Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi

Local information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel app...

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Autores principales: Khundi, McEwen, Carpenter, James R., Corbett, Elizabeth L., Feasey, Helena R. A., Soko, Rebecca Nzawa, Nliwasa, Marriott, Twabi, Hussein, Chiume, Lingstone, Burke, Rachael M., Horton, Katherine C., Dodd, Peter J., Cohen, Ted, MacPherson, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9126376/
https://www.ncbi.nlm.nih.gov/pubmed/35605004
http://dx.doi.org/10.1371/journal.pone.0268749
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author Khundi, McEwen
Carpenter, James R.
Corbett, Elizabeth L.
Feasey, Helena R. A.
Soko, Rebecca Nzawa
Nliwasa, Marriott
Twabi, Hussein
Chiume, Lingstone
Burke, Rachael M.
Horton, Katherine C.
Dodd, Peter J.
Cohen, Ted
MacPherson, Peter
author_facet Khundi, McEwen
Carpenter, James R.
Corbett, Elizabeth L.
Feasey, Helena R. A.
Soko, Rebecca Nzawa
Nliwasa, Marriott
Twabi, Hussein
Chiume, Lingstone
Burke, Rachael M.
Horton, Katherine C.
Dodd, Peter J.
Cohen, Ted
MacPherson, Peter
author_sort Khundi, McEwen
collection PubMed
description Local information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel approach, adjusting CNRs for under-notification (P:N ratio) using neighbourhood-level predictors of TB prevalence-to-notification ratios. We analysed data from 1) a citywide routine TB surveillance system including geolocation, confirmatory mycobacteriology, and clinical and demographic characteristics of all registering TB patients in Blantyre, Malawi during 2015–19, and 2) an adult TB prevalence survey done in 2019. In the prevalence survey, consenting adults from randomly selected households in 72 neighbourhoods had symptom-plus-chest X-ray screening, confirmed with sputum smear microscopy, Xpert MTB/Rif and culture. Bayesian multilevel models were used to estimate adjusted neighbourhood prevalence-to-notification ratios, based on summarised posterior draws from fitted adult bacteriologically-confirmed TB CNRs and prevalence. From 2015–19, adult bacteriologically-confirmed CNRs were 131 (479/371,834), 134 (539/415,226), 114 (519/463,707), 56 (283/517,860) and 46 (258/578,377) per 100,000 adults per annum, and 2019 bacteriologically-confirmed prevalence was 215 (29/13,490) per 100,000 adults. Lower educational achievement by household head and neighbourhood distance to TB clinic was negatively associated with CNRs. The mean neighbourhood P:N ratio was 4.49 (95% credible interval [CrI]: 0.98–11.91), consistent with underdiagnosis of TB, and was most pronounced in informal peri-urban neighbourhoods. Here we have demonstrated a method for the identification of neighbourhoods with high levels of under-diagnosis of TB without the requirement for a prevalence survey; this is important since prevalence surveys are expensive and logistically challenging. If confirmed, this approach may support more efficient and effective targeting of intensified TB and HIV case-finding interventions aiming to accelerate elimination of urban TB.
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spelling pubmed-91263762022-05-24 Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi Khundi, McEwen Carpenter, James R. Corbett, Elizabeth L. Feasey, Helena R. A. Soko, Rebecca Nzawa Nliwasa, Marriott Twabi, Hussein Chiume, Lingstone Burke, Rachael M. Horton, Katherine C. Dodd, Peter J. Cohen, Ted MacPherson, Peter PLoS One Research Article Local information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel approach, adjusting CNRs for under-notification (P:N ratio) using neighbourhood-level predictors of TB prevalence-to-notification ratios. We analysed data from 1) a citywide routine TB surveillance system including geolocation, confirmatory mycobacteriology, and clinical and demographic characteristics of all registering TB patients in Blantyre, Malawi during 2015–19, and 2) an adult TB prevalence survey done in 2019. In the prevalence survey, consenting adults from randomly selected households in 72 neighbourhoods had symptom-plus-chest X-ray screening, confirmed with sputum smear microscopy, Xpert MTB/Rif and culture. Bayesian multilevel models were used to estimate adjusted neighbourhood prevalence-to-notification ratios, based on summarised posterior draws from fitted adult bacteriologically-confirmed TB CNRs and prevalence. From 2015–19, adult bacteriologically-confirmed CNRs were 131 (479/371,834), 134 (539/415,226), 114 (519/463,707), 56 (283/517,860) and 46 (258/578,377) per 100,000 adults per annum, and 2019 bacteriologically-confirmed prevalence was 215 (29/13,490) per 100,000 adults. Lower educational achievement by household head and neighbourhood distance to TB clinic was negatively associated with CNRs. The mean neighbourhood P:N ratio was 4.49 (95% credible interval [CrI]: 0.98–11.91), consistent with underdiagnosis of TB, and was most pronounced in informal peri-urban neighbourhoods. Here we have demonstrated a method for the identification of neighbourhoods with high levels of under-diagnosis of TB without the requirement for a prevalence survey; this is important since prevalence surveys are expensive and logistically challenging. If confirmed, this approach may support more efficient and effective targeting of intensified TB and HIV case-finding interventions aiming to accelerate elimination of urban TB. Public Library of Science 2022-05-23 /pmc/articles/PMC9126376/ /pubmed/35605004 http://dx.doi.org/10.1371/journal.pone.0268749 Text en © 2022 Khundi et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Khundi, McEwen
Carpenter, James R.
Corbett, Elizabeth L.
Feasey, Helena R. A.
Soko, Rebecca Nzawa
Nliwasa, Marriott
Twabi, Hussein
Chiume, Lingstone
Burke, Rachael M.
Horton, Katherine C.
Dodd, Peter J.
Cohen, Ted
MacPherson, Peter
Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi
title Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi
title_full Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi
title_fullStr Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi
title_full_unstemmed Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi
title_short Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi
title_sort neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in blantyre, malawi
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9126376/
https://www.ncbi.nlm.nih.gov/pubmed/35605004
http://dx.doi.org/10.1371/journal.pone.0268749
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