Diagnostic yield as an important metric for the evaluation of novel tuberculosis tests: rationale and guidance for future research

The Lancet Global Health, Journal Year: 2024, Volume and Issue: 12(7), P. e1184 - e1191

Published: June 13, 2024

Better access to tuberculosis testing is a key priority for fighting tuberculosis, the leading cause of infectious disease deaths in people. Despite roll-out molecular WHO-recommended rapid diagnostics replace sputum smear microscopy over past decade, large diagnostic gap remains. Of estimated 10·6 million people who developed globally 2022, more than 3·1 were not diagnosed. An exclusive focus on improving test accuracy alone will be sufficient close tuberculosis. Diagnostic yield, which we define as proportion whom identifies among all attempt an important metric adequately explored. yield particularly relevant subpopulations unable produce such young children, living with HIV, and subclinical As accessible non-sputum specimens (eg, urine, oral swabs, saliva, capillary blood, breath) are being explored point-of-care testing, concept growing importance. Using example urine lipoarabinomannan illustrate how even tests limited sensitivity can diagnose if they enable increased yield. tongue swab-based another example, provide definitions guidance design conduct pragmatic studies that assess Lastly, show other characteristics, cost implementation feasibility, essential effective population coverage, required optimal clinical care transmission impact. We calling incorporated into evaluation processes, including WHO Grading Recommendations, Assessment, Development, Evaluations process, providing crucial real-life complements traditional measures.

Language: Английский

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Effectiveness of testing, contact tracing and isolation interventions among the general population on reducing transmission of SARS-CoV-2: a systematic review

Philosophical Transactions of the Royal Society A Mathematical Physical and Engineering Sciences, Journal Year: 2023, Volume and Issue: 381(2257)

Published: Aug. 23, 2023

We conducted a systematic literature review of general population testing, contact tracing, case isolation and quarantine interventions to assess their effectiveness in reducing SARS-CoV-2 transmission, as implemented real-world settings. designed broad search strategy aimed identify peer-reviewed studies any design provided there was quantitative measure on transmission outcome. Studies that assessed the effect testing or diagnosis disease outcomes via treatment, but did not outcome, were included. focused among rather than specific settings; these from anywhere world published time after 1 January 2020 until end 2022. From 26 720 titles abstracts, 1181 reviewed full text, 25 met our inclusion criteria. These included one randomized control trial (RCT) remaining 24 analysed empirical data made some attempt for confounding. categorized by type intervention: tracing (seven studies); strategies (12 isolating cases/contacts (four 'test, trace, isolate' (TTI) part package (two studies). None rated at low risk bias many serious bias, particularly due likely presence uncontrolled confounding factors, which major challenge assessing independent effects TTI observational studies. factors are be expected during an on-going pandemic, when emphasis epidemic burden design. Findings suggested important public health role followed isolation, especially where mass serial used reduce transmission. Some most compelling analyses came examining fine-grained within-country tracing; while broader compared behaviour between countries also often found led reduced mortality, this universal. There limited evidence benefit away home environment. One study, RCT, showed daily contacts could viable replace lengthy contacts. Based scarcity robust evidence, we able draw firm conclusions about impact different contexts. While majority scale is only available scenarios hence necessarily generalizable. Our therefore emphasizes need conduct experimental help inform optimal Work needed support such context future emerging epidemics, along with assessments cost-effectiveness interventions, beyond scope will critical decision-making. This article theme issue 'The non-pharmaceutical COVID-19 pandemic: evidence'.

Language: Английский

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Hospitalization burden and epidemiology of the COVID-19 pandemic in Spain (2020–2021)

BMC Infectious Diseases, Journal Year: 2023, Volume and Issue: 23(1)

Published: July 18, 2023

Spain had some of Europe's highest incidence and mortality rates for coronavirus disease 2019 (COVID-19). Here we describe the epidemiology trends in hospitalizations, number critical patients, deaths 2020 2021.We performed a descriptive, retrospective, nationwide study using an administrative database, Minimum Basic Data Set at Hospitalization, which includes 95-97% discharge reports patients hospitalized 2021. We analyzed admissions to intensive care units, their geographic distribution across regions Spain.As December 31, 2021, total 498,789 (1.04% entire Spanish population) needed hospitalization. At least six waves illness were identified. Men more prone hospitalization than women. The median age was 66. A 54,340 (10.9% all hospitalizations) been admitted unit. identified 71,437 (mortality rate 14.3% among patients). also observed important differences regions, with Madrid being epicenter hospitalizations mortality.We Spain's response COVID-19 here its experiences during pandemic terms illness, deaths. This research highlights changes over several months importance factors such as vaccination, predominant variant virus, public health interventions rise fall outbreaks.

Language: Английский

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At-home testing for respiratory viruses: a minireview of the current landscape

Journal of Clinical Microbiology, Journal Year: 2024, Volume and Issue: 62(5)

Published: March 4, 2024

The landscape of at-home testing using over-the-counter (OTC) tests has been evolving over the last decade. United States Food and Drug Administration Emergency Use Authorization rule in effect since early 2000s, it was widely employed during severe acute respiratory syndrome coronavirus 2 pandemic to authorize antigen nucleic acid detection for use central laboratories as well OTC. During pandemic, first viruses became available consumer use, which opened door additional virus OTC tests. Concerns may exist regarding public's ability properly collect samples, perform testing, interpret results, report results public health authorities. However, favorable comparison studies between centralized laboratory test suggest that have a place healthcare, is likely here stay. This mini-review viral diseases will briefly cover regulatory reimbursement environment, current availability, advantages limitations

Language: Английский

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Non-pharmaceutical interventions to reduce COVID-19 transmission in the UK: a rapid mapping review and interactive evidence gap map

Journal of Public Health, Journal Year: 2024, Volume and Issue: 46(2), P. e279 - e293

Published: Feb. 29, 2024

Abstract Background Non-pharmaceutical interventions (NPIs) were crucial in the response to COVID-19 pandemic, although uncertainties about their effectiveness remain. This work aimed better understand evidence generated during pandemic on of NPIs implemented UK. Methods We conducted a rapid mapping review (search date: 1 March 2023) identify primary studies reporting reduce transmission. Included displayed an interactive gap map. Results After removal duplicates, 11 752 records screened. Of these, 151 included, including 100 modelling but only 2 randomized controlled trials and 10 longitudinal observational studies. Most reported isolate those who are or may become infectious, number contacts. There was for hand respiratory hygiene, ventilation cleaning. Conclusions Our findings show that despite large published, there is still lack robust evaluations need build evaluation into design implementation public health policies from start any future other emergency.

Language: Английский

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System-wide approaches to antimicrobial therapy and antimicrobial resistance in the UK: the AMR-X framework

The Lancet Microbe, Journal Year: 2024, Volume and Issue: 5(5), P. e500 - e507

Published: March 7, 2024

Summary

Antimicrobial resistance (AMR) threatens human, animal, and environmental health. Acknowledging the urgency of addressing AMR, an opportunity exists to extend AMR action-focused research beyond confines isolated biomedical paradigm. An learning system, AMR-X, envisions a national network health systems creating applying optimal use antimicrobials on basis their data collected from delivery routine clinical care. AMR-X integrates traditional discovery, experimental research, applied with continuous analysis pathogens, antimicrobial uses, outcomes that are routinely disseminated practitioners, policy makers, patients, public drive changes in practice outcomes. uses connected data-to-action underpin evaluation framework embedded care, continuously driving implementation improvements patient population health, targeting investment, incentivising innovation. All stakeholders co-create protecting by adapting evolving threats generating information needed for precision

Language: Английский

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Key SARS-CoV-2 testing strategies implemented in the UK: rationale and impact

Journal of the Royal Society of Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 28, 2025

Language: Английский

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Re-evaluating national screening for chronic kidney disease in the UK

BMJ, Journal Year: 2023, Volume and Issue: unknown, P. e074265 - e074265

Published: July 31, 2023

Language: Английский

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The Crucial Role of Laboratory Medicine in Addressing Future Public Health Infectious Threats: Insights Gained from the COVID-19 Pandemic

Diagnostics, Journal Year: 2025, Volume and Issue: 15(3), P. 323 - 323

Published: Jan. 30, 2025

Laboratory testing has played a pivotal role throughout the coronavirus disease 2019 (COVID-19) pandemic, exemplifying importance of in vitro diagnostics addressing public health threats posed by outbreaks infectious diseases. This article aims to present key insights from our expertise, derived evidence gathered during COVID-19 inform strategies for managing future challenges. Current scientific underscores that patient sample not only allows diagnose an acute severe respiratory syndrome 2 (SARS-CoV-2) infection, but also supports outbreak prediction, improved control measures, anticipation pressure on healthcare system, mitigation adverse clinical outcomes, and early detection emerging SARS-CoV-2 variants. Additionally, wastewater monitoring emerged as powerful tool forecasting burden, including both prevalence severity. Collectively, these findings underscore value diagnostic surveillance guiding planning optimizing resource allocation offering valid framework be applied threats, especially any potential “Disease X” may emerge future.

Language: Английский

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Cost-effectiveness of wastewater-based environmental surveillance for SARS-CoV-2 in Blantyre, Malawi and Kathmandu, Nepal: A model-based study

PLOS Global Public Health, Journal Year: 2025, Volume and Issue: 5(4), P. e0004439 - e0004439

Published: April 24, 2025

Wastewater-based environmental surveillance (ES) has been demonstrated to provide an early warning signal predict variant-driven waves of pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our study evaluated the potential cost-effectiveness ES for SARS-CoV-2 compared with clinical testing alone. We used Covasim agent-based model COVID-19 simulate disease transmission hypothetical populations in Blantyre, Malawi, and Kathmandu, Nepal. simulated introduction a new immune-escaping variant over 6 months estimated health outcomes (cases, deaths, disability-adjusted life years [DALYs]) economic impact when using trigger moderate proactive behavioral intervention (e.g., increased use masks, social distancing) by policymakers versus no hence delayed reactive intervention. Costs considered included ES, testing, treatment, productivity loss entire population due implementation calculated incremental ratios these local willingness-to-pay thresholds: $61 Malawi $249 performed sensitivity analyses evaluate key assumptions on results. are reported 2022 US dollars. estimate that if were implemented, approximately 600 DALYs would be averted Blantyre 300 six-month period. Considering system costs, was cost-effective cost-saving Kathmandu. Cost-effectiveness highest settings low surveillance, high severity, effectiveness. However, from societal perspective, may not depending magnitude population-wide losses associated threshold. or tool perspective linked effective public response. From however, length its consequences make cost-effective. Implementing multiple improve cost-effectiveness.

Language: Английский

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