Impact of community-wide tuberculosis active case finding and Human Immunodeficiency Virus testing on tuberculosis trends in Malawi

Burke, R. M. et al. (2023) Impact of community-wide tuberculosis active case finding and Human Immunodeficiency Virus testing on tuberculosis trends in Malawi. Clinical Infectious Diseases, 77(1), pp. 94-100. (doi: 10.1093/cid/ciad238) (PMID:37099318) (PMCID:PMC10320183)

Abstract

Background: Tuberculosis case-finding interventions are critical to meeting World Health Organization End TB strategy goals. We investigated the impact of community-wide tuberculosis active case-finding (ACF) alongside scale-up of HIV testing and care on trends in adult tuberculosis case notification rates (CNRs) in Blantyre, Malawi. Methods: Five rounds of ACF for tuberculosis (1-2 weeks of leafleting, door-to-door enquiry for cough and sputum microscopy) were delivered to neighbourhoods (“ACF areas”) in North-West Blantyre between April 2011 and August 2014. Many of these neighborhoods also had concurrent HIV testing interventions. The remaining neighbourhoods in Blantyre City (“non-ACF areas”) provided a non-randomised comparator. We analyzed TB CNRs from January 2009 until December 2018. We used interrupted time series analysis to compare tuberculosis CNRs before ACF and after ACF, and between ACF and non-ACF areas. Findings: Tuberculosis CNRs increased in Blantyre concurrently with start of ACF for tuberculosis in both ACF and non-ACF areas, with a larger magnitude in ACF areas. Compared to a counterfactual where pre-ACF CNR trends continued during ACF period, we estimated there were an additional 101 (95% confidence interval [CI] 42 to 160) microbiologically confirmed (Bac+) tuberculosis diagnoses per 100,000 person-years in the ACF areas in three and a half years of ACF. Compared to a counterfactual where trends in ACF area were the same as trends in non-ACF areas, we estimated an additional 63 (95% CI 38 to 90) Bac+ diagnoses per 100,000 person-years in the same period. Interpretation: Tuberculosis ACF was associated with a rapid increase in people diagnosed with tuberculosis in Blantyre.

• Item Type: Articles
• Additional Information: This work was supported by Wellcome through grants awarded to ELC (091769/Z/10/Z and 200901/Z/16/Z). ELC also received support through an institutional Clinical PhD grant to London School of Hygiene and Tropical Medicine. RMB and PM are also supported by the Wellcome (203905/Z/16/Z and 206575/Z/17/Z, respectively). PJD was supported by a fellowship from the UK Medical Research Council (MR/P022081/1); this UK funded award is part of the EDCTP2 programme supported by the European Union.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Burke, R. M., Nliwasa, M., Dodd, P. J., Feasey, H. R., Khundi, M., Choko, A., Nzawa-Soko, R., Mpunga, J., Webb, E. L., Fielding, K., MacPherson, P., and Corbett, E. L.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Clinical Infectious Diseases
• Publisher: Oxford University Press
• ISSN: 1058-4838
• ISSN (Online): 1537-6591
• Published Online: 26 April 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Clinical Infectious Diseases 77(1):94-100
• Publisher Policy: Reproduced under a Creative Commons License