Post by The Lancet Infectious Diseases

📢 In active tuberculosis case-finding at the community level in Lesotho and South-Africa, the combination of computer-aided detection (CAD) on digital X-rays followed by C-reactive protein (CRP) testing offers no advantage over CAD alone due to inferior case yield and higher cost. CAD alone, however, has the potential to be an effective and cost-effective tuberculosis community screening tool in areas with high disease burden. 🫁Klaus Reither, Fiona Vanobberghen, Anna Verjans, Harsh Vivek Harkare and colleagues conducted a pragmatic trial applying a paired screen-positive design at the community level (n=20023) participants in the Butha-Buthe District in Lesotho and the uMgungundlovu District in South Africa. Two screening approaches to diagnose tuberculosis were compared: the use CAD software on digital chest x-rays alone (the CAD4TBv7 approach) and the use of CAD followed by a CRP test if the CAD score was in a particular range (the CAD4TBv7-CRP approach). A confirmatory Xpert MTB/RIF Ultra test was conducted when required by the algorithm of one or both approaches. Co-primary outcomes were: yield of detected TB cases per study approach, testing non-inferiority of CAD4TBv7-CRP vs CAD4TBv7; and cost-effectiveness. 📊 CAD4TBv7-CRP approach did not demonstrate non-inferiority compared to CAD4TBv7, had a 12% lower case yield, and was more costly (37·3% more expensive). 💡 Both digital chest radiography with CAD and CRP testing are recommended by WHO as screening tools (with CRP testing currently recommended for people living with HIV only). First head-to-head comparison of CAD4TBv7-CRP and CAD4TBv7 approaches for active tuberculosis case-finding in the community. This data is important for informing the design and implementation of future tuberculosis screening strategies by key stakeholders. Read the full paper here: https://bit.ly/44bY9yL #tuberculosis, #screening, #community, #computeraideddetection, #C-reactiveprotein Bart K M Jacobs, Alastair van Heerden, Shriya Misra, Fabrizio Tediosi, Curdin Brugger, Niklaus Daniel Labhardt, Mashaete Kamele, Mamatlakeng Keitseng, Thandanani Madonsela, Johanna Kurscheid, Josephine Muhairwe, Alfred Kipyegon Keter, Keelin Murphy, Bram van Ginneken, Tinne Gils, Bulemba Katende, Rediet Fikru Gebresenbet, Rahel Milena Erhardt, Thomas Zoller, TOM Decroo, Tracy Renée Glass, Lut Lynen, Aita Signorell, Shannon Bosman, Irene Ayakaka