TY - JOUR
T1 - Twelve-monthly versus six-monthly radiological screening for active case-finding of tuberculosis
T2 - A randomised controlled trial
AU - Churchyard, Gavin J.
AU - Fielding, Katherine
AU - Roux, Surita
AU - Corbett, Elizabeth L.
AU - Chaisson, Richard E.
AU - De Cock, Kevin M.
AU - Hayes, Richard J.
AU - Grant, Alison D.
N1 - Funding Information:
Funding This study was funded by the Safety In Mines Research Advisory Council of South Africa (SIMHEALTH Gen 524). GJC and KF were funded by Aurum Institute for Health Research. ELC was funded by a Wellcome Trust Training Fellowship in Clinical Tropical Medicine. ADG was supported by a UK Department of Health Public Health Career Scientist award. GJC and KF are funded by the Consortium to Respond Effectively to the AIDS TB Epidemic.
PY - 2011/2
Y1 - 2011/2
N2 - Background: The incidence of tuberculosis has increased among South African gold miners despite comprehensive control programmes, including a radiological screening programme. No data are available as to the optimal frequency of screening. The aim of this study was to compare 6-monthly and 12-monthly radiological screening for active tuberculosis case-finding. Methods: Employees of a gold mining company were randomly assigned to the control arm (screening at baseline, 12 and 24 months) or the intervention arm (additional 'intervention' radiographs at 6 and 18 months after baseline). Study outcomes included proportion of tuberculosis cases detected by screening, proportion smear-positive, extent of disease and mortality. Results: 22 634 miners were randomised. Compared with 12-monthly screening, 6-monthly screening detected more tuberculosis suspects but not more cases, partly due to greater attrition between screening and further investigation after 'intervention' compared with routine radiographs. Tuberculosis cases detected in the 6-monthly versus the 12-monthly screening arm had less extensive disease (p=0.05) and a lower tuberculosis-specific mortality (death on tuberculosis treatment) (2.1 and 2.8 per 1000 person-years respectively, HR 0.73, 95% CI 0.50 to 1.08, p=0.1), which was most marked in the first 2 months of treatment (HR 0.48, 95% CI 0.23 to 0.98, p=0.04) when death from tuberculosis is most likely. Discussion: In settings with a high prevalence of HIV and tuberculosis despite standard tuberculosis control measures, more frequent case-finding may reduce the extent of disease, tuberculosis mortality and tuberculosis transmission through earlier detection of active tuberculosis cases. To be effective, however, all tuberculosis suspects identified through screening must be investigated for tuberculosis.
AB - Background: The incidence of tuberculosis has increased among South African gold miners despite comprehensive control programmes, including a radiological screening programme. No data are available as to the optimal frequency of screening. The aim of this study was to compare 6-monthly and 12-monthly radiological screening for active tuberculosis case-finding. Methods: Employees of a gold mining company were randomly assigned to the control arm (screening at baseline, 12 and 24 months) or the intervention arm (additional 'intervention' radiographs at 6 and 18 months after baseline). Study outcomes included proportion of tuberculosis cases detected by screening, proportion smear-positive, extent of disease and mortality. Results: 22 634 miners were randomised. Compared with 12-monthly screening, 6-monthly screening detected more tuberculosis suspects but not more cases, partly due to greater attrition between screening and further investigation after 'intervention' compared with routine radiographs. Tuberculosis cases detected in the 6-monthly versus the 12-monthly screening arm had less extensive disease (p=0.05) and a lower tuberculosis-specific mortality (death on tuberculosis treatment) (2.1 and 2.8 per 1000 person-years respectively, HR 0.73, 95% CI 0.50 to 1.08, p=0.1), which was most marked in the first 2 months of treatment (HR 0.48, 95% CI 0.23 to 0.98, p=0.04) when death from tuberculosis is most likely. Discussion: In settings with a high prevalence of HIV and tuberculosis despite standard tuberculosis control measures, more frequent case-finding may reduce the extent of disease, tuberculosis mortality and tuberculosis transmission through earlier detection of active tuberculosis cases. To be effective, however, all tuberculosis suspects identified through screening must be investigated for tuberculosis.
UR - http://www.scopus.com/inward/record.url?scp=79251613745&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79251613745&partnerID=8YFLogxK
U2 - 10.1136/thx.2010.139048
DO - 10.1136/thx.2010.139048
M3 - Article
C2 - 21098802
AN - SCOPUS:79251613745
SN - 0040-6376
VL - 66
SP - 134
EP - 139
JO - Thorax
JF - Thorax
IS - 2
ER -