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Tuberculosis, more commonly referred to as TB, is an infectious disease stemming from Mycobacterium tuberculosis. While it primarily impacts the lungs, TB can also affect other body areas. Given its severity and global impact, timely and accurate diagnosis is crucial for controlling its spread and improving patient outcomes.
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What Is the Optimal Community-Based Tuberculosis Screening Algorithm for People Who Inject Drugs in a High-Burden

Morgana D'Ottavi1, Hong Thi Tran2, Hai Nguyen2

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Summary

A new community-based screening algorithm significantly improves tuberculosis (TB) detection among people who inject drugs (PWID) in Vietnam. This optimized approach enhances sensitivity and yield compared to current methods, offering a more effective strategy for this high-risk population.

Keywords:
community-based approachescost-efficiencypeople who use drugssubclinical tuberculosistuberculosis screening

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Medical Diagnostics

Background:

  • People who inject drugs (PWID) represent a population with a high risk for tuberculosis (TB).
  • Current TB case-finding strategies are insufficient for identifying the majority of TB cases within the PWID community.
  • There is a critical need for improved, community-based screening algorithms to enhance TB detection in this vulnerable group.

Purpose of the Study:

  • To develop and evaluate an optimized community-based screening algorithm for tuberculosis detection among people who inject drugs (PWID).
  • To identify the most cost-effective screening strategy with the highest TB case detection rate.
  • To compare the performance of different on-site testing combinations.

Main Methods:

  • Respondent-driven sampling was used to recruit PWID in Hai Phong, Vietnam.
  • Screening included TB symptoms, C-reactive protein, portable chest x-ray with CAD4TB, and sputum Xpert MTB/RIF.
  • A "gold standard" diagnosis was established through referral, confirmatory testing, and external validation.

Main Results:

  • Out of 1080 PWID enrolled, 47 (4.4%) were diagnosed with TB.
  • A systematic chest x-ray with CAD4TB, followed by Xpert MTB/RIF for specific CAD4TB scores, and targeted referral, doubled TB detection sensitivity (82.9% vs 43.9%) and yield (3.2% vs 1.7%).
  • This enhanced algorithm maintained a reasonable cost per TB case detected (US $439) compared to the standard of care (US $309).

Conclusions:

  • An effective and moderately priced algorithm was identified for community-based TB screening among PWID in Vietnam.
  • Active case-finding and systematic screening should not solely rely on symptom-based detection to accurately reflect TB prevalence.
  • The study advocates for broader screening strategies beyond symptom-based approaches in high-risk populations.