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Comparing different technologies for active TB case-finding among the homeless: a transmission-dynamic modelling
Tendai Mugwagwa1,2, Helen R Stagg3, Ibrahim Abubakar3,4
1Modelling and Economics Unit, National Infection Service, Public Health England, London, UK. tendai.mugwagwa@phe.gov.uk.
Scientific Reports
|January 25, 2018
Summary
Active case-finding strategies for tuberculosis (TB) in homeless populations are crucial. Mobile Chest X-ray and GeneXpert screening, alongside enhanced case management, can improve treatment adherence and reduce TB transmission.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Homeless individuals face higher tuberculosis (TB) risks and limited healthcare access.
- Effective active case-finding (ACF) and tailored treatment strategies are essential for this population.
Purpose of the Study:
- To evaluate the effectiveness and efficiency of different screening methods for TB in homeless populations.
- To determine optimal screening strategies considering disease prevalence and patient adherence.
Main Methods:
- A transmission-dynamic model was employed to simulate screening scenarios.
- Evaluated mobile Chest X-ray, GeneXpert, and combined approaches.
- Assessed impact of patient willingness to wait for results and treatment adherence.
Main Results:
- ACF efficiency is linked to TB prevalence thresholds (e.g., 78/100,000 without enhanced case management).
- One-step GeneXpert screening is often most efficient, but two-step (X-ray then GeneXpert) is preferred if many patients decline waiting.
- Enhanced case management significantly lowers TB prevalence thresholds for efficient ACF.
Conclusions:
- Targeted ACF and support services improve health outcomes by enabling early treatment and preventing TB spread.
- The most effective TB screening strategy is context-dependent, requiring adaptation to specific patient needs and local conditions.
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