Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data

Abstract Background Ratios of bacteriologically positive tuberculosis (TB) prevalence to notification rates are used to characterise typical durations of TB disease. However, this ignores the clinical spectrum of tuberculosis disease and potentially long infectious periods with minimal or no symptom...

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Autores principales:	Chu-Chang Ku, Peter MacPherson, McEwen Khundi, Rebecca H. Nzawa Soko, Helena R. A. Feasey, Marriott Nliwasa, Katherine C. Horton, Elizabeth L. Corbett, Peter J. Dodd
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Tuberculosis Sub-clinical tuberculosis Bayesian statistics Care-seeking Epidemiology Medicine R
Acceso en línea:	https://doaj.org/article/319c955f167243e286d11992d06e8d02
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spelling	oai:doaj.org-article:319c955f167243e286d11992d06e8d022021-11-14T12:17:09ZDurations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data10.1186/s12916-021-02128-91741-7015https://doaj.org/article/319c955f167243e286d11992d06e8d022021-11-01T00:00:00Zhttps://doi.org/10.1186/s12916-021-02128-9https://doaj.org/toc/1741-7015Abstract Background Ratios of bacteriologically positive tuberculosis (TB) prevalence to notification rates are used to characterise typical durations of TB disease. However, this ignores the clinical spectrum of tuberculosis disease and potentially long infectious periods with minimal or no symptoms prior to care-seeking. Methods We developed novel statistical models to estimate progression from initial bacteriological positivity including smear conversion, symptom onset and initial care-seeking. Case-detection ratios, TB incidence, durations, and other parameters were estimated by fitting the model to tuberculosis prevalence survey and notification data (one subnational and 11 national datasets) within a Bayesian framework using Markov chain Monte Carlo methods. Results Analysis across 11 national datasets found asymptomatic tuberculosis durations in the range 4–8 months for African countries; three countries in Asia (Cambodia, Lao PDR, and Philippines) showed longer durations of > 1 year. For the six countries with relevant data, care-seeking typically began half-way between symptom onset and notification. For Kenya and Blantyre, Malawi, individual-level data were available. The sex-specific durations of asymptomatic bacteriologically-positive tuberculosis were 9.0 months (95% credible interval [CrI]: 7.2–11.2) for men and 8.1 months (95% CrI: 6.2–10.3) for women in Kenya, and 4.9 months (95% CrI: 2.6–7.9) for men and 3.5 months (95% CrI: 1.3–6.2) for women in Blantyre. Age-stratified analysis of data for Kenya showed no strong age-dependence in durations. For Blantyre, HIV-stratified analysis estimated an asymptomatic duration of 1.3 months (95% CrI: 0.3–3.0) for HIV-positive people, shorter than the 8.5 months (95% CrI: 5.0–12.7) for HIV-negative people. Additionally, case-detection ratios were higher for people living with HIV than HIV-negative people (93% vs 71%). Conclusion Asymptomatic TB disease typically lasts around 6 months. We found no evidence of age-dependence, but much shorter durations among people living with HIV, and longer durations in some Asian settings. To eradicate TB transmission, greater gains may be achieved by proactively screening people without symptoms through active case finding interventionsChu-Chang KuPeter MacPhersonMcEwen KhundiRebecca H. Nzawa SokoHelena R. A. FeaseyMarriott NliwasaKatherine C. HortonElizabeth L. CorbettPeter J. DoddBMCarticleTuberculosisSub-clinical tuberculosisBayesian statisticsCare-seekingEpidemiologyMedicineRENBMC Medicine, Vol 19, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tuberculosis Sub-clinical tuberculosis Bayesian statistics Care-seeking Epidemiology Medicine R
spellingShingle	Tuberculosis Sub-clinical tuberculosis Bayesian statistics Care-seeking Epidemiology Medicine R Chu-Chang Ku Peter MacPherson McEwen Khundi Rebecca H. Nzawa Soko Helena R. A. Feasey Marriott Nliwasa Katherine C. Horton Elizabeth L. Corbett Peter J. Dodd Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data
description	Abstract Background Ratios of bacteriologically positive tuberculosis (TB) prevalence to notification rates are used to characterise typical durations of TB disease. However, this ignores the clinical spectrum of tuberculosis disease and potentially long infectious periods with minimal or no symptoms prior to care-seeking. Methods We developed novel statistical models to estimate progression from initial bacteriological positivity including smear conversion, symptom onset and initial care-seeking. Case-detection ratios, TB incidence, durations, and other parameters were estimated by fitting the model to tuberculosis prevalence survey and notification data (one subnational and 11 national datasets) within a Bayesian framework using Markov chain Monte Carlo methods. Results Analysis across 11 national datasets found asymptomatic tuberculosis durations in the range 4–8 months for African countries; three countries in Asia (Cambodia, Lao PDR, and Philippines) showed longer durations of > 1 year. For the six countries with relevant data, care-seeking typically began half-way between symptom onset and notification. For Kenya and Blantyre, Malawi, individual-level data were available. The sex-specific durations of asymptomatic bacteriologically-positive tuberculosis were 9.0 months (95% credible interval [CrI]: 7.2–11.2) for men and 8.1 months (95% CrI: 6.2–10.3) for women in Kenya, and 4.9 months (95% CrI: 2.6–7.9) for men and 3.5 months (95% CrI: 1.3–6.2) for women in Blantyre. Age-stratified analysis of data for Kenya showed no strong age-dependence in durations. For Blantyre, HIV-stratified analysis estimated an asymptomatic duration of 1.3 months (95% CrI: 0.3–3.0) for HIV-positive people, shorter than the 8.5 months (95% CrI: 5.0–12.7) for HIV-negative people. Additionally, case-detection ratios were higher for people living with HIV than HIV-negative people (93% vs 71%). Conclusion Asymptomatic TB disease typically lasts around 6 months. We found no evidence of age-dependence, but much shorter durations among people living with HIV, and longer durations in some Asian settings. To eradicate TB transmission, greater gains may be achieved by proactively screening people without symptoms through active case finding interventions
format	article
author	Chu-Chang Ku Peter MacPherson McEwen Khundi Rebecca H. Nzawa Soko Helena R. A. Feasey Marriott Nliwasa Katherine C. Horton Elizabeth L. Corbett Peter J. Dodd
author_facet	Chu-Chang Ku Peter MacPherson McEwen Khundi Rebecca H. Nzawa Soko Helena R. A. Feasey Marriott Nliwasa Katherine C. Horton Elizabeth L. Corbett Peter J. Dodd
author_sort	Chu-Chang Ku
title	Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data
title_short	Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data
title_full	Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data
title_fullStr	Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data
title_full_unstemmed	Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data
title_sort	durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a bayesian analysis of prevalence survey and notification data
publisher	BMC
publishDate	2021
url	https://doaj.org/article/319c955f167243e286d11992d06e8d02
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Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data

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