Yield of facility-based targeted universal testing for tuberculosis with Xpert and mycobacterial culture in high-risk groups attending primary care facilities in South Africa

Berhanu, Rebecca H.Lebina, LimakatsoNonyane, Bareng A.S.Milovanovic, MinjaKinghorn, AnthonyNyathi, SiphoYoung, KatherineHausler, HarryNaidoo, PrenBrey, ZameerShearer, KateGenade, LeishaMartinson, Neil A.2024-04-292024-04-292023-05Berhanu, R.H., Lebina, L., Nonyane, B.A.S. et al. 2023, 'Yield of facility-based targeted universal testing for tuberculosis with Xpert and mycobacterial culture in high-risk groups attending primary care facilities in South Africa', Clinical Infectious Diseases, vol. 76, no. 9, pp. 1594-1603, doi : 10.1093/cid/ciac965.1058-4838 (print)1537-6591 (online)10.1093/cid/ciac965http://hdl.handle.net/2263/95782DATA SHARING : Individual participant data that underlie the results reported in this article, after de-identification, the data dictionary, study protocol, statistical analysis plan, and analytic code will be made available to investigators whose proposed use of the data has been approved by an independent review committee to achieve aims in the approved proposal. Proposals should be submitted to N. A. M. (martinson@phru.co.za). To gain access, data requestors will need to sign a data access agreement.BACKGROUND : We report the yield of targeted universal tuberculosis (TB) testing of clinic attendees in high-risk groups. METHODS : Clinic attendees in primary healthcare facilities in South Africa with one of the following risk factors underwent sputum testing for TB: human immunodeficiency virus (HIV), contact with a TB patient in the past year, and having had TB in the past 2 years. A single sample was collected for Xpert-Ultra (Xpert) and culture. We report the proportion positive for Mycobacterium tuberculosis. Data were analyzed descriptively. The unadjusted clinical and demographic factors’ relative risk of TB detected by culture or Xpert were calculated and concordance between Xpert and culture is described. RESULTS : A total of 30 513 participants had a TB test result. Median age was 39 years, and 11 553 (38%) were men. The majority (n=21734, 71%) had HIV, 12 492 (41%) reported close contact with a TB patient, and 1573 (5%) reported prior TB. Overall, 8.3% were positive for M. tuberculosis by culture and/or Xpert compared with 6.0% with trace-positive results excluded. In asymptomatic participants, the yield was 6.7% and 10.1% in symptomatic participants (with trace-positives excluded). Only 10% of trace-positive results were culture-positive. We found that 55% of clinic attendees with a sputum result positive for M. tuberculosis did not have a positive TB symptom screen. CONCLUSIONS : A high proportion of clinic attendees with specific risk factors (HIV, close TB contact, history of TB) test positive for M. tuberculosis when universal testing is implemented.en© The Author(s) 2023. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence.Active case-findingXpertSubclinical tuberculosisTuberculosis (TB)SDG-03: Good health and well-beingHealth sciences articles SDG-03SDG-10: Reduced inequalitiesSDG-03: Good health and well-beingHealth sciences articles SDG-01SDG-01: No povertyHealth sciences articles SDG-10Yield of facility-based targeted universal testing for tuberculosis with Xpert and mycobacterial culture in high-risk groups attending primary care facilities in South AfricaArticle