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Radio + TB
At the moment, each year only 70% (7 million) of the world's estimated 10 million tuberculosis (TB) cases are picked up and started on treatment. A major goal of the End-TB strategy over the next few years is to "find these missing millions". To do this we need a more proactive approach and need to embrace technological advances. Digital chest X-Ray, increasingly being recommended as a screening tool, can pick up the earliest signs of disease on the lungs before the patient has any symptoms and therefore identify people who need sputum testing for TB (usually with Xpert). Each year millions of people are screened for TB with digital chest X-Ray. An emerging issue with this approach is that it finds lots of people who look like they have TB on the chest X-ray but their sputum test is negative. We know these people are at very high risk to developing TB in subsequent years, but there is currently no agreed simplified approach on how to treat this group in these settings and they often become part of the lost TB cases. Part of the problem is that no clinical trials have been done for this group for over 35 years. Before we undertake such trials we want to define how best to identify those that may have bacteriologically-negative TB. We will evaluate combining two new tests. Firstly we will use software which uses artificial intelligence to analyse the chest x-ray image (know as a computer-aided-diagnostic (CAD) system) to see if the pattern suggests TB. This software provides an answer in minutes at low cost. If the software thinks the chest X-Ray looks like TB, we want to conduct a second test on a small volume of blood. This blood sample is placed directly into a cartridge and loaded onto a machine and analysed for a genetic pattern which suggests the body is fighting TB, with an answer available in 2 hours. The main objectives of this study are: 1 A) To determine the optimal CAD system (of 3) and threshold score for (i) detection of early TB lesions on chest X-ray and CT scan (ii) detection of baseline culture positive disease (iii) prediction of future culture positive disease AND B) To establish if adding the TB Host Response Blood test to the CAD can increase the predictive value for baseline culture positive disease and future culture positive disease 2 A) To determine the proportion of people presenting to primary care with TB symptoms triaged with chest x-ray who have CAD score above threshold (from objective 1) and positive TB host response blood test and determine the predictive value for baseline and future culture positivity and association with empirical treatment decision AND B) To determine the proportion of people screened with chest x-ray in household contact settings who have CAD score above threshold and positive TB host response blood test and determine the predictive value for baseline and future culture positivity 3) Establish what patients think of this new approach and what would they value the most in treatment? Short duration, high success rate or certainty of diagnosis?
1 Researchers
  • Inst of Clinical Trials &Methodology
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