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dc.contributor.authorKhundi, Mcewen
dc.contributor.authorCarpenter, James R.
dc.contributor.authorCorbett, Elizabeth L.
dc.contributor.authorFeasey, Helena R. A.
dc.contributor.authorSoko, Rebecca Nzawa
dc.contributor.authorNliwasa, Marriott
dc.contributor.authorTwabi, Hussein
dc.contributor.authorChiume, Lingstone
dc.contributor.authorBurke, Rachael M.
dc.contributor.authorHorton, Katherine C.
dc.contributor.authorDodd, Peter J.
dc.contributor.authorCohen, Ted
dc.contributor.authorMacpherson, Peter
dc.identifier.citationKhundi , M , Carpenter , J R , Corbett , E L , Feasey , H R A , Soko , R N , Nliwasa , M , Twabi , H , Chiume , L , Burke , R M , Horton , K C , Dodd , P J , Cohen , T & Macpherson , P 2022 , ' Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi ' , PLoS ONE , vol. 17 , no. 5 , e0268749 .
dc.identifier.othercrossref: 10.1371/journal.pone.0268749
dc.identifier.otherORCID: /0000-0003-3109-6722/work/148420984
dc.descriptionFunding: This work was supported by two grants from Wellcome Trust (ELC grant number WT200901/Z/16/Z) and (PM grant number 200901/Z/16/Z). JRC was funded by UK Medical Research Council (MRC) programme grant MC_UU_00004/07. PJD was supported by a fellowship from the MRC (MR/P022081/1); this UK funded award was part of the EDCTP2 programme supported by the European Union. RMB was funded by Wellcome Trust (203905/16/Z). KCH was supported by the European Research Council (757699) and UK FCDO (Leaving no-one behind: transforming gendered pathways to health for TB). TC was supported by US NIH R01 R01AI147854.en
dc.description.abstractLocal information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel approach, adjusting CNRs for under-notification (P:N ratio) using neighbourhood-level predictors of TB prevalence-to-notification ratios. We analysed data from 1) a citywide routine TB surveillance system including geolocation, confirmatory mycobacteriology, and clinical and demographic characteristics of all registering TB patients in Blantyre, Malawi during 2015–19, and 2) an adult TB prevalence survey done in 2019. In the prevalence survey, consenting adults from randomly selected households in 72 neighbourhoods had symptom-plus-chest X-ray screening, confirmed with sputum smear microscopy, Xpert MTB/Rif and culture. Bayesian multilevel models were used to estimate adjusted neighbourhood prevalence-to-notification ratios, based on summarised posterior draws from fitted adult bacteriologically-confirmed TB CNRs and prevalence. From 2015–19, adult bacteriologically-confirmed CNRs were 131 (479/371,834), 134 (539/415,226), 114 (519/463,707), 56 (283/517,860) and 46 (258/578,377) per 100,000 adults per annum, and 2019 bacteriologically-confirmed prevalence was 215 (29/13,490) per 100,000 adults. Lower educational achievement by household head and neighbourhood distance to TB clinic was negatively associated with CNRs. The mean neighbourhood P:N ratio was 4.49 (95% credible interval [CrI]: 0.98–11.91), consistent with underdiagnosis of TB, and was most pronounced in informal peri-urban neighbourhoods. Here we have demonstrated a method for the identification of neighbourhoods with high levels of under-diagnosis of TB without the requirement for a prevalence survey; this is important since prevalence surveys are expensive and logistically challenging. If confirmed, this approach may support more efficient and effective targeting of intensified TB and HIV case-finding interventions aiming to accelerate elimination of urban TB.
dc.relation.ispartofPLoS ONEen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.titleNeighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawien
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.description.statusPeer revieweden

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