Bornali Datta1, Ashish Prakash2, David Ford3, Jaya Prasad Tripathy4, Pinky Goyal2, Shreya Singh5, Veena Singh6, Anand Jaiswal1, Naresh Trehan7. 1. Director, Department of Respiratory Medicine, Medanta the Medicity, Gurgaon, Haryana, India. 2. Consultant, Department of Respiratory Medicine, Medanta the Medicity, Gurgaon, Haryana, India. 3. Consultant, Department of Respiratory Medicine, Scarborough General Hospital, Scarborough, UK. 4. Assistant Professor, Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India. 5. Resident Doctor, Kasturba Medical College, Manipal, India. 6. Director Health Services, Civil Hospital, Sector-6, Panchkula, Haryana, India. 7. Chairman and Managing Director, Medanta the Medicity, Gurgaon, Haryana, India.
Abstract
BACKGROUND: The Tuberculosis (TB) Control Program in India changed the TB diagnostic algorithm and recommended sputum testing and chest x-ray (CXR) for presumptive TB up front. There is no experience of testing this algorithm in routine field settings. METHODS: In a public-private partnership (PPP), a private hospital provided mobile digital CXR services (mounted on a van) to complement the existing diagnostic services of sputum microscopy and GeneXpert testing. All presumptive TB patients (cough >2 weeks) underwent CXR and sputum microscopy, and GeneXpert testing if eligible (smear-negative CXR suggestive of TB). RESULTS: All 2973 presumptive TB patients underwent CXR and sputum microscopy; 471 (15.8%) had abnormal CXR findings suggestive of TB, 129 (4.3%) were smear positive and 17 were extrapulmonary TB. Of the remaining 325 with smear-negative and CXR suggestive of TB, 147 (45.2%) underwent GeneXpert testing, yielding 32 positives (21.8%). Of the remaining 178 with no GeneXpert test done, 106 (60.0%) had CXR definitely suggesting TB (clinically diagnosed TB). Thus a total of 284 cases of TB (161 microbiologically confirmed, 106 clinically diagnosed, 17 extrapulmonary TB) were identified, giving a potential diagnostic yield of 19.6%. CONCLUSIONS: Systematic screening with mobile digital X-ray service via a PPP model integrated into the national program is feasible and scalable with a high yield.
BACKGROUND: The Tuberculosis (TB) Control Program in India changed the TB diagnostic algorithm and recommended sputum testing and chest x-ray (CXR) for presumptive TB up front. There is no experience of testing this algorithm in routine field settings. METHODS: In a public-private partnership (PPP), a private hospital provided mobile digital CXR services (mounted on a van) to complement the existing diagnostic services of sputum microscopy and GeneXpert testing. All presumptive TBpatients (cough >2 weeks) underwent CXR and sputum microscopy, and GeneXpert testing if eligible (smear-negative CXR suggestive of TB). RESULTS: All 2973 presumptive TBpatients underwent CXR and sputum microscopy; 471 (15.8%) had abnormal CXR findings suggestive of TB, 129 (4.3%) were smear positive and 17 were extrapulmonary TB. Of the remaining 325 with smear-negative and CXR suggestive of TB, 147 (45.2%) underwent GeneXpert testing, yielding 32 positives (21.8%). Of the remaining 178 with no GeneXpert test done, 106 (60.0%) had CXR definitely suggesting TB (clinically diagnosed TB). Thus a total of 284 cases of TB (161 microbiologically confirmed, 106 clinically diagnosed, 17 extrapulmonary TB) were identified, giving a potential diagnostic yield of 19.6%. CONCLUSIONS: Systematic screening with mobile digital X-ray service via a PPP model integrated into the national program is feasible and scalable with a high yield.
Authors: Emily A Kendall; Hamidah Hussain; Amber Kunkel; Rachel W Kubiak; Anete Trajman; Richard Menzies; Paul K Drain Journal: BMC Med Date: 2021-12-14 Impact factor: 11.150
Authors: Courtney M Yuen; Daniela Puma; Ana Karina Millones; Jerome T Galea; Christine Tzelios; Roger I Calderon; Meredith B Brooks; Judith Jimenez; Carmen Contreras; Tim C Nichols; Tom Nicholson; Leonid Lecca; Mercedes C Becerra; Salmaan Keshavjee Journal: BMJ Open Date: 2021-07-07 Impact factor: 2.692