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A comparison of digital chest radiography and Xpert® MTB/RIF in active case finding for tuberculosis

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OBJECTIVE: To compare two community screening tests for TB: sputum examination using Xpert® MTB/RIF and chest radiography (CXR).

METHOD: Men aged ≥15 years and women aged >45 years living in 96 sub-communes in Ca Mau, Viet Nam, were invited to provide a single sputum specimen that was tested using Xpert. Participants were also invited to attend a nearby location for digital radiography. Participants whose sputum was Xpert MTB-positive or whose CXR was reported as ‘consistent with TB´ were requested to provide two further sputum specimens for culture. The sensitivities of the two tests for detecting TB (defined as sputum culture-positive for Mycobacterium tuberculosis) were compared.

RESULTS: There were 72 985 eligible participants, of whom 57 597 (78.9%) participated in Xpert screening, 12 752 (17.5%) had CXR and 11 235 (15.4%) had both tests. We estimated that there were 59 cases of TB, of whom 20 were Xpert MTB-positive (programmatic sensitivity 34.0%) and 47 had CXR reported as ‘consistent with TB´ (sensitivity 80.0%, P < 0.0001).

CONCLUSION: In community-wide screening for TB, CXR is more sensitive than a single spontaneously expectorated sputum sample tested using Xpert, but it has a substantially lower participation rate.

Keywords: TB; diagnostic; radiography; screening; sensitivity

Document Type: Research Article

Affiliations: 1: Woolcock Institute of Medical Research, Hanoi, Viet Nam 2: Woolcock Institute of Medical Research, Hanoi, Viet Nam, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia 3: National TB Control Programme, Hanoi, Centre for Social Disease Control, Ca Mau 4: National Lung Hospital, Hanoi, Hanoi Medical University, Hanoi 5: University of Medicine and Pharmacy, Ho Chi Minh city, Viet Nam 6: National TB Control Programme, Hanoi, National Lung Hospital, Hanoi, Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France 7: Global Tuberculosis Program, World Health Organization, Geneva, Switzerland 8: Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia, National TB Control Programme, Hanoi, National Lung Hospital, Hanoi, Hanoi Medical University, Hanoi 9: Woolcock Institute of Medical Research, Hanoi, Viet Nam, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia, South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia

Publication date: September 1, 2020

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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