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Head-to-head comparison of nasal and nasopharyngeal sampling using SARS-CoV-2 rapid antigen testing in Lesotho

Labhardt, Niklaus D. ; González Fernández, Lucia ; Katende, Bulemba ; [et al.]

Public Library of Science (PLoS) ; 2023

In: PLOS ONE Vol. 18, No. 3 ( 2023-3-2), p. e0278653-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 3 ( 2023-3-2), p. e0278653-

Abstract: To assess the real-world diagnostic performance of nasal and nasopharyngeal swabs for SD Biosensor STANDARD Q COVID-19 Antigen Rapid Diagnostic Test (Ag-RDT). Methods Individuals ≥5 years with COVID-19 compatible symptoms or history of exposure to SARS-CoV-2 presenting at hospitals in Lesotho received two nasopharyngeal and one nasal swab. Ag-RDT from nasal and nasopharyngeal swabs were performed as point-of-care on site, the second nasopharyngeal swab used for polymerase chain reaction (PCR) as the reference standard. Results Out of 2198 participants enrolled, 2131 had a valid PCR result (61% female, median age 41 years, 8% children), 84.5% were symptomatic. Overall PCR positivity rate was 5.8%. The sensitivity for nasopharyngeal, nasal, and combined nasal and nasopharyngeal Ag-RDT result was 70.2% (95%CI: 61.3–78.0), 67.3% (57.3–76.3) and 74.4% (65.5–82.0), respectively. The respective specificity was 97.9% (97.1–98.4), 97.9% (97.2–98.5) and 97.5% (96.7–98.2). For both sampling modalities, sensitivity was higher in participants with symptom duration ≤ 3days versus ≤ 7days. Agreement between nasal and nasopharyngeal Ag-RDT was 99.4%. Conclusions The STANDARD Q Ag-RDT showed high specificity. Sensitivity was, however, below the WHO recommended minimum requirement of ≥ 80%. The high agreement between nasal and nasopharyngeal sampling suggests that for Ag-RDT nasal sampling is a good alternative to nasopharyngeal sampling.

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0278653

DOI: 10.1371/journal.pone.0278653.g001

DOI: 10.1371/journal.pone.0278653.g002

DOI: 10.1371/journal.pone.0278653.g003

DOI: 10.1371/journal.pone.0278653.t001

DOI: 10.1371/journal.pone.0278653.t002

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2023

detail.hit.zdb_id: 2267670-3

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Creating access to SARS-CoV-2 screening and testing through community-based COVID-19 case-finding, observations from cross-sectional studies in Lesotho and Zambia

Klinkenberg, Eveline ; Katende, Bulemba ; Ruperez, Maria ; [et al.]

Springer Science and Business Media LLC ; 2023

In: BMC Public Health Vol. 23, No. 1 ( 2023-07-24)

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In: BMC Public Health, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-07-24)

Abstract: The health impact of the COVID-19 pandemic largely depends on the ability of the healthcare systems to develop effective and adaptable preparedness and mitigation strategies. A collaborative initiative (BRCCH-EDCTP COVID-19 Initiative) was set up between Lesotho and Zambia early on in the pandemic, to jointly conduct a project to investigate creating access to SARS-CoV-2 screening and testing through community-based COVID-19 case-finding. Methods Two different community case-finding strategies were deployed. In Lesotho, an approach was implemented whereby a community (village) health worker screened community members at their home or during community gatherings for COVID-19 signs and symptoms. All community members who screened positive were then offered SARS-CoV-2 testing. In Zambia, so-called community hubs, staffed by community health care workers, were set up at different locations in the community for people to walk in and get tested for SARS-CoV-2. Hubs changed location from week-to-week and targeted transmission hotspots. All persons visiting the hubs were offered testing for SARS-CoV-2 irrespective of self-reported signs and symptoms of COVID-19 though information was collected on occurrence of these. Testing in both approaches was done using SARS-CoV-2 rapid antigen tests. Results Setting up testing in the community setting was feasible in both countries. In Lesotho in the village health worker approach, over a period of 46 weeks, 7221 persons were screened, and 49 (11.4%) SARS-COV-2 cases identified among 428 COVID-19 screen positive participants. In the community hubs among 3150 people tested, 166 (5.3%) SARS-CoV-2 cases were identified in a period of 26 weeks. From the community hubs approach, where all seen were offered COVID-19 testing it was learned that people screening positive for COVID-19 signs and symptoms were more likely to test SARS-COV-2 positive, especially those reporting classic COVID-19 symptoms like loss of sense/smell for a short period of time (1–3 days). Conclusions In conclusion, in this project we learned that implementing COVID-19 screening and testing by lay health workers in the community is possible. Characteristics of the population screened, tested, and identified to have SARS-CoV-2 are described to help guide development of future testing strategies.

Type of Medium: Online Resource

ISSN: 1471-2458

URL: Article

DOI: 10.1186/s12889-023-16306-2

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

detail.hit.zdb_id: 2041338-5

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Incidental radiological findings during clinical tuberculosis screening in Lesotho and South Africa: a case series

Glaser, Naomi ; Bosman, Shannon ; Madonsela, Thandanani ; [et al.]

Springer Science and Business Media LLC ; 2023

In: Journal of Medical Case Reports Vol. 17, No. 1 ( 2023-08-25)

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In: Journal of Medical Case Reports, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2023-08-25)

Abstract: Chest X-ray offers high sensitivity and acceptable specificity as a tuberculosis screening tool, but in areas with a high burden of tuberculosis, there is often a lack of radiological expertise to interpret chest X-ray. Computer-aided detection systems based on artificial intelligence are therefore increasingly used to screen for tuberculosis-related abnormalities on digital chest radiographies. The CAD4TB software has previously been shown to demonstrate high sensitivity for chest X-ray tuberculosis-related abnormalities, but it is not yet calibrated for the detection of non-tuberculosis abnormalities. When screening for tuberculosis, users of computer-aided detection need to be aware that other chest pathologies are likely to be as prevalent as, or more prevalent than, active tuberculosis. However, non-tuberculosis chest X-ray abnormalities detected during chest X-ray screening for tuberculosis remain poorly characterized in the sub-Saharan African setting, with only minimal literature. Case presentation In this case series, we report on four cases with non-tuberculosis abnormalities detected on CXR in TB TRIAGE + ACCURACY (ClinicalTrials.gov Identifier: NCT04666311), a study in adult presumptive tuberculosis cases at health facilities in Lesotho and South Africa to determine the diagnostic accuracy of two potential tuberculosis triage tests: computer-aided detection (CAD4TB v7, Delft, the Netherlands) and C-reactive protein (Alere Afinion, USA). The four Black African participants presented with the following chest X-ray abnormalities: a 59-year-old woman with pulmonary arteriovenous malformation, a 28-year-old man with pneumothorax, a 20-year-old man with massive bronchiectasis, and a 47-year-old woman with aspergilloma. Conclusions Solely using chest X-ray computer-aided detection systems based on artificial intelligence as a tuberculosis screening strategy in sub-Saharan Africa comes with benefits, but also risks. Due to the limitation of CAD4TB for non-tuberculosis-abnormality identification, the computer-aided detection software may miss significant chest X-ray abnormalities that require treatment, as exemplified in our four cases. Increased data collection, characterization of non-tuberculosis anomalies and research on the implications of these diseases for individuals and health systems in sub-Saharan Africa is needed to help improve existing artificial intelligence software programs and their use in countries with high tuberculosis burden.

Type of Medium: Online Resource

ISSN: 1752-1947

URL: Article

DOI: 10.1186/s13256-023-04097-4

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

detail.hit.zdb_id: 2269805-X

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Linkage to care and treatment outcomes for patients diagnosed with drug-susceptible tuberculosis using Xpert MTB/RIF assay in Thaba-Tseka district in Lesotho

Mabote, Nteseng ; Mamo, Meseret ; Nsakala, Bienvenu ; [et al.]

Elsevier BV ; 2022

In: IJID Regions Vol. 5 ( 2022-12), p. 33-38

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In: IJID Regions, Elsevier BV, Vol. 5 ( 2022-12), p. 33-38

Type of Medium: Online Resource

ISSN: 2772-7076

URL: Article

DOI: 10.1016/j.ijregi.2022.08.010

Language: English

Publisher: Elsevier BV

Publication Date: 2022

detail.hit.zdb_id: 3106389-5

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Diagnosis of SARS-CoV-2 infection from breath - a proof-of-concept study

Katende, Bulemba ; Fernández, Lucia González ; Muhairwe, Josephine ; [et al.]

Elsevier BV ; 2022

In: IJID Regions Vol. 5 ( 2022-12), p. 163-164

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In: IJID Regions, Elsevier BV, Vol. 5 ( 2022-12), p. 163-164

Type of Medium: Online Resource

ISSN: 2772-7076

URL: Article

DOI: 10.1016/j.ijregi.2022.10.007

Language: English

Publisher: Elsevier BV

Publication Date: 2022

detail.hit.zdb_id: 3106389-5

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Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Katende, Bulemba ; Bresser, Moniek ; Kamele, Mashaete ; [et al.]

Public Library of Science (PLoS) ; 2023

In: PLOS Global Public Health Vol. 3, No. 8 ( 2023-8-2), p. e0001488-

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In: PLOS Global Public Health, Public Library of Science (PLoS), Vol. 3, No. 8 ( 2023-8-2), p. e0001488-

Abstract: The surge of the COVID-19 pandemic challenged health services globally, and in Lesotho, the HIV and tuberculosis (TB) services were similarly affected. Integrated, multi-disease diagnostic services were proposed solutions to mitigate these disruptions. We describe and evaluate the effect of an integrated, hospital-based COVID-19, TB and HIV screening and diagnostic model in two rural districts in Lesotho, during the period between December 2020 and August 2022. Adults, hospital staff, and children above 5 years attending two hospitals were pre-screened for COVID-19 and TB symptoms. After a positive pre-screening, participants were offered to enroll in a service model that included clinical evaluation, chest radiography, SARS-CoV-2, TB, and HIV testing. Participants diagnosed with COVID-19, TB, or HIV were contacted after 28 days to evaluate their health status and linkage to HIV and/or TB care services. Of the 179160 participants pre-screened, 6623(3.7%) pre-screened positive, and 4371(66%) were enrolled in this service model. Of the total 458 diagnoses, only 17 happened in children. One positive rapid antigen test for SARS-CoV-2 was found per 11 participants enrolled, one Xpert-positive TB case was diagnosed per 85 people enrolled, and 1 new HIV diagnosis was done per 182 people enrolled. Of the 321(82.9%) participants contacted after 28 days of diagnosis, 304(94.7%) reported to be healthy. Of the individuals that were newly diagnosed with HIV or TB, 18/24(75.0%) and 46/51(90.1%) started treatment within 28 days of the diagnosis. This screening and diagnostic model successfully maintained same-day, integrated COVID-19, TB, and HIV testing services, despite frequent disruptions caused by the surge of COVID-19 waves, healthcare seeking patterns, and the volatile context (social measures, travel restrictions, population lockdowns). There were positive effects in avoiding diagnostic delays and ensuring linkage to services, however, diagnostic yields for adults and children were low. To inform future preparedness plans, research will need to identify essential health interventions and how to optimize them along each phase of the emergency response.

Type of Medium: Online Resource

ISSN: 2767-3375

URL: Article

DOI: 10.1371/journal.pgph.0001488

DOI: 10.1371/journal.pgph.0001488.g001

DOI: 10.1371/journal.pgph.0001488.g002

DOI: 10.1371/journal.pgph.0001488.t001

DOI: 10.1371/journal.pgph.0001488.t002

DOI: 10.1371/journal.pgph.0001488.t003

DOI: 10.1371/journal.pgph.0001488.s001

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2023

detail.hit.zdb_id: 3101394-6

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Rifampicin Resistant Tuberculosis in Lesotho: Diagnosis, Treatment Initiation and Outcomes

Katende, Bulemba ; Esterhuizen, Tonya M. ; Dippenaar, Anzaan ; [et al.]

Springer Science and Business Media LLC ; 2020

In: Scientific Reports Vol. 10, No. 1 ( 2020-02-05)

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In: Scientific Reports, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2020-02-05)

Abstract: The Lesotho guidelines for the management of drug-resistant tuberculosis (TB) recommend initiation of patients diagnosed with rifampicin resistant (RR)-TB on a standardized drug resistant regimen while awaiting confirmation of rifampicin resistant TB (RR-TB) and complete drug susceptibility test results. Review of diagnostic records between 2014 and 2016 identified 518 patients with RR-TB. Only 314 (60.6%) patients could be linked to treatment records at the Lesotho MDR hospital. The median delay in treatment initiation from the availability of Xpert MTB/RIF assay result was 12 days (IQR 7–19). Only 32% (101) of patients had a documented first-line drug resistant test. MDR-TB was detected in 56.4% of patients while 33.7% of patients had rifampicin mono-resistance. Only 7.4% of patients assessed for second-line resistance had a positive result (resistance to fluoroquinolone). Treatment success was 69.8%, death rate was 28.8%, loss to follow up was 1.0%, and 0.4% failed treatment. Death was associated with positive or unavailable sputum smear at the end of first month of treatment (Fisher exact p 〈 0.001) and older age (p = 0.007). Urgent attention needs to be given to link patients with RR-TB to care worldwide. The association of death rate with positive sputum smear at the end of the first month of treatment should trigger early individualization of treatment.

Type of Medium: Online Resource

ISSN: 2045-2322

URL: Article

DOI: 10.1038/s41598-020-58690-4

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2020

detail.hit.zdb_id: 2615211-3

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