Bezuidenhout Charl, Long Lawrence, Nichols Brooke, Meyer-Rath Gesine, Fox Matthew P, Olifant Sharon, Theron Grant, Fiphaza Kuhle, Pieruccini Maria, Ruhwald Morten, Penn-Nicholson Adam, Fourie Bernard, Medina-Marino Andrew
Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
BMJ Glob Health. 2025 Aug 21;10(8):e018131. doi: 10.1136/bmjgh-2024-018131.
Effective strategies are essential for early tuberculosis (TB) detection. Reliance on passive case detection, symptom screening and collection of sputum results in delayed or undiagnosed TB, contributing to on-going TB transmission. This study assessed the acceptability of in-home targeted universal TB testing (TUTT) using GeneXpert MTB/RIF Ultra at point-of-care (POC) during household contact investigations (HCIs) and the feasibility of using sputum and tongue swab specimens.
The TB Home Study sought to evaluate the predictive value of different specimen types for use as a household-level triage test for TB. Household contacts of people with TB residing in the Buffalo City Metro Health District (Eastern Cape Province, South Africa) who received in-home POC TUTT through the TB Home Study were asked to complete a post-test acceptability survey. The survey assessed the level of comfort, confidence in the test results and perceived appropriateness of in-home POC TUTT. A feasibility framework was used to assess the feasibility of using sputum and tongue swab specimens for testing.
Of the 325 eligible household contacts, 281/325 (86.5%) provided consent. Of those contacts, 278/281 (98.9%) provided a tongue swab, and 50/281 (17.8%) could expectorate sputum. All specimens were successfully prepared for immediate in-home testing. Of the 172 tongue swab-based tests performed, 169 (98.3%) produced a valid result, whereas 47 of 49 (95.9%) sputum-based tests had a valid result. An immediate tongue swab-based test result was available for 274/278 (98.6%) clients compared with 47/49 (95.9%) sputum-based test results. The mean in-home POC TUTT acceptability score (5=highly acceptable) was 4.2/5 (SD=0.4).
In-homePOC TUTT using sputum and tongue swab specimens was highly acceptable and feasible. Tongue swabs greatly increased the testing rates owing to the high sample collection yield. Combining sputum and tongue swabs for in-home POC testing offers a promising strategy to improve TB case detection and reduce diagnostic delays.
有效的策略对于早期结核病（TB）检测至关重要。依赖被动病例发现、症状筛查和痰液采集会导致结核病诊断延迟或未被诊断，从而助长结核病的持续传播。本研究评估了在家庭接触者调查（HCI）期间使用GeneXpert MTB/RIF Ultra在现场即时检测（POC）进行家庭靶向普遍结核病检测（TUTT）的可接受性，以及使用痰液和舌拭子标本的可行性。
结核病家庭研究旨在评估不同标本类型作为家庭层面结核病分流检测的预测价值。通过结核病家庭研究接受家庭现场即时检测TUTT的南非东开普省布法罗市地铁卫生区结核病患者的家庭接触者被要求完成检测后可接受性调查。该调查评估了舒适度、对检测结果的信心以及家庭现场即时检测TUTT的感知适宜性。使用可行性框架评估使用痰液和舌拭子标本进行检测的可行性。
在325名符合条件的家庭接触者中，281/325（86.5%）提供了同意。在这些接触者中，278/281（98.9%）提供了舌拭子，50/281（17.8%）能够咳出痰液。所有标本均成功制备用于即时家庭检测。在172次基于舌拭子的检测中（169/172，98.3%）产生了有效结果，而在49次基于痰液的检测中，47次（95.9%）有有效结果。与47/49（95.9%）基于痰液的检测结果相比，274/278（98.6%）的客户可获得即时基于舌拭子的检测结果。家庭现场即时检测TUTT的平均可接受性评分（5分=高度可接受）为4.2/5（标准差=0.4）。
使用痰液和舌拭子标本进行家庭现场即时检测TUTT是高度可接受且可行的。由于样本采集率高，舌拭子大大提高了检测率。将痰液和舌拭子结合用于家庭现场即时检测为改善结核病病例发现和减少诊断延迟提供了一种有前景的策略。
