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Published on: April 5, 2017
Community-wide Screening for Tuberculosis in a High-Prevalence Setting
Guy B Marks1, Nhung V Nguyen1, Phuong T B Nguyen1
1From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.).
Active community-wide tuberculosis screening significantly reduced prevalence in Vietnam. This public health strategy shows promise for achieving global tuberculosis elimination targets.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Clinical Trials
Background:
- The World Health Organization has established ambitious goals for global tuberculosis elimination.
- Current progress rates are insufficient to meet these targets, necessitating innovative strategies.
Purpose of the Study:
- To evaluate the effectiveness of active community-wide tuberculosis screening compared to standard passive case detection.
- To determine the impact of screening on tuberculosis prevalence in Ca Mau Province, Vietnam.
Main Methods:
- A cluster-randomized controlled trial was conducted in Ca Mau Province, Vietnam.
- Annual screening for pulmonary tuberculosis using nucleic acid amplification testing was performed in 60 intervention clusters for three years.
- Control clusters received standard passive case detection only.
Main Results:
- Pulmonary tuberculosis prevalence was significantly lower in the intervention group (126 per 100,000) compared to the control group (226 per 100,000) in the fourth year (prevalence ratio, 0.56; P<0.001).
- No significant difference in tuberculosis infection prevalence was observed in children born in 2012 between the groups.
Conclusions:
- Three years of community-wide screening effectively reduced pulmonary tuberculosis prevalence.
- Active screening is a viable strategy to accelerate progress towards global tuberculosis elimination goals.
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