Tuberculosis: Findings & Accomplishments to Date

Findings & Accomplishments to Date 

  • Developed a clinical score, building on the WHO clinical manual, that is easy to implement in low resource settings (Wejse, ScandJInfDis 2008+ Rudolf ScandJInfDis 2013). The team validated the score with data from a cohort of 698 TB patients, assessing sensitivity to change and ability to predict mortality. The tool is equally useful with HIV-infected and HIV-uninfected patients, as well as in smear negative and smear positive patients, and is now used as an outcome in landmark TB trials, such as the GeneXpert TB diagnostic trial on roll-out in standard settings in Africa (Lancet 2014).
  • Conducted a TB prevalence/intervention survey in one site so far (Bjerregaard-Andersen, BMC Inf Dis 2010). The survey in the HDSS in Guinea Bissau demonstrated that 25% of the encountered TB cases were unknown by the health care system.
  • Demonstrated the major impact of tuberculosis exposure at home on general child mortality which is twice as high in affected households, seven-fold if the mother of the child was the TB index case. (Gomes, Thorax 2011).
  • Leveraged HDSS facilities and experienced field assistants, to document that with simple measures such as 1 month follow-up visit, one can enhance identification of TB cases and increase the diagnostic yield by 6% (Porskrog, IJTLD 2011).
  • Used HDSS data to show proof of concept and effect of Isoniazid preventive therapy for TB exposed children through a comparison with the intervention group and background population (Gomes IJTLD 2011 + BMJOpen 2012)
  • Using seed-funding support from INDEPTH, completed cross site studies on TB suspects in four sites (Bissau, Karonga, Kisumu and Filabavi) as well as completed TB risk factors studies in three sites (Bissau, Karonga, Vadu).

Current and Future Activities

HDSSs have an advantage in addressing the goal of TB elimination because of their ability to conduct cost-effective tests of low-cost interventions such as house-to-house visits by field assistants, and large-scale preventive treatment. Further, only in HDSSs it is possible through the longitudinal data collection to demonstrate the effects of such interventions on a population level.

The team seeks to demonstrate how the simple clinical score they have developed can be implemented in low resource settings, pilot its use across sites and encourage policy makers to support its rollout.

  • A clinically trained person with a scale, a measuring tape and a thermometer can assess severity of TB and triage who needs the attention in a resource poor environment in order to lower mortality within the existing health care facilities.
  • The team seeks to pilot its use in several HDSS sites and then use longitudinal tracking to show increasing identification of severe TB cases, and hopefully measure a decrease in TB mortality.

The long term goal of the present research within preventive therapy for latent TB is to ensure that the strategy gets deployed in high burden areas.