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Tuberculosis
Original research
Decline in prevalence of tuberculosis following an intensive case finding campaign and the COVID-19 pandemic in an urban Ugandan community
  1. Emily A Kendall1,2,3,
  2. Peter J Kitonsa2,4,
  3. Annet Nalutaaya2,
  4. Katherine O Robsky3,
  5. Kamoga Caleb Erisa2,
  6. James Mukiibi2,
  7. Adithya Cattamanchi2,5,6,
  8. Midori Kato-Maeda6,
  9. Achilles Katamba2,4,
  10. David Dowdy2,3
  1. 1 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
  3. 3 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4 Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
  5. 5 Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Orange, California, USA
  6. 6 Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
  1. Correspondence to Dr Emily A Kendall, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21787, USA; ekendall{at}jhmi.edu

Abstract

Background Systematic screening is a potential tool for reducing the prevalence of tuberculosis (TB) and counteracting COVID-19-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of TB over time.

Methods We conducted serial, cross-sectional TB case finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum for TB testing (Xpert MTB/RIF Ultra) from all adolescents and adults. We estimated the prevalence of TB among screening participants in each campaign and compared characteristics of people with TB across campaigns. We simultaneously enrolled and characterised community residents who were diagnosed with TB through routine care and assessed trends in facility-based diagnosis.

Results We successfully screened 12 033 community residents (35% of the estimated adult/adolescent population) in 2019 and 11 595 (33%) in 2021. In 2019, 0.94% (95% CI: 0.77% to 1.13%) of participants tested Xpert positive (including trace). This proportion fell to 0.52% (95% CI: 0.40% to 0.67%) in 2021; the prevalence ratio was 0.55 (95% CI: 0.40 to 0.75)). There was no change in the age (median 26 vs 26), sex (56% vs 59% female) or prevalence of chronic cough (49% vs 54%) among those testing positive. By contrast, the rate of routine facility-based diagnosis remained steady in the 8 months before each campaign (210 (95% CI: 155 to 279) vs 240 (95% CI: 181 to 312) per 100 000 per year).

Conclusions Following an intensive initial case finding campaign in an urban Ugandan community in 2019, the burden of prevalent TB as measured by systematic screening had decreased by 45% in 2021, despite the intervening COVID-19 pandemic.

  • tuberculosis
  • COVID-19
  • clinical epidemiology

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/thorax-2023-220047

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @emilyakendall, @davidwdowdy

    • Contributors DD conceptualised the project, and DD, MK-M, EAK, AC and AK contributed to funding acquisition. PJK, JM and KCE contributed to data collection along with other members of the STOMP-TB study team. DD (project PI), AK (local PI), EAK (scientific lead), AC (parent research consortium), MK-M (laboratory) and PJK (local coordinator) provided supervision. AN and EAK curated data. EAK performed formal analysis, wrote the original draft and generated figures. DD and all authors contributed to manuscript review and editing. EAK accepts full responsibility for the finished work, had access to the data, and controlled the decision to publish.

    • Funding This work was supported by the National Institutes of Health (grant numbers R01HL138728 to DD, K08AI127908 to EAK, R01HL153611 to EAK and F32HL158019 to KOR).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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