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[Preprint]. 2024 Nov 2:2024.11.01.24316570.

doi: 10.1101/2024.11.01.24316570.

USING SPUTUM AND TONGUE SWAB SPECIMENS FOR IN-HOME POINT-OF-CARE TARGETED UNIVERSAL TESTING FOR TB OF HOUSEHOLD CONTACTS: AN ACCEPTABILITY AND FEASIBILITY ANALYSIS

Charl Bezuidenhout¹, Lawrence Long^{1

2}, Brooke Nichols^{1

3

4}, Gesine Meyer-Rath^{1

2

5}, Matthew P Fox^{1

2

6}, Sharon Olifant⁷, Grant Theron⁸, Kuhle Fiphaza^{9

10}, Morten Ruhwald¹¹, Adam Penn-Nicholson¹¹, Bernard Fourie⁷, Andrew Medina-Marino^{9

10

12}

Affiliations

¹ Department of Global Health, Boston University School of Public Health, Boston, U.S.
² Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
³ Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
⁴ Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, the Netherlands.
⁵ South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, South Africa.
⁶ Department of Epidemiology, Boston University School of Public Health, Boston, USA; 1. Department of Global Health, Boston University School of Public Health, Boston, USA.
⁷ Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
⁸ DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹ Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
¹⁰ Eastern Cape Research Site, Desmond Tutu Health Foundation, East London, South Africa.
¹¹ FIND, Geneva, Switzerland.
¹² Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania.

PMID: 39574838
PMCID: PMC11581095
DOI: 10.1101/2024.11.01.24316570

USING SPUTUM AND TONGUE SWAB SPECIMENS FOR IN-HOME POINT-OF-CARE TARGETED UNIVERSAL TESTING FOR TB OF HOUSEHOLD CONTACTS: AN ACCEPTABILITY AND FEASIBILITY ANALYSIS

Charl Bezuidenhout et al. medRxiv. 2024.

[Preprint]. 2024 Nov 2:2024.11.01.24316570.

doi: 10.1101/2024.11.01.24316570.

Authors

Affiliations

¹ Department of Global Health, Boston University School of Public Health, Boston, U.S.
² Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
³ Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
⁴ Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, the Netherlands.
⁵ South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, South Africa.
⁶ Department of Epidemiology, Boston University School of Public Health, Boston, USA; 1. Department of Global Health, Boston University School of Public Health, Boston, USA.
⁷ Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
⁸ DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹ Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
¹⁰ Eastern Cape Research Site, Desmond Tutu Health Foundation, East London, South Africa.
¹¹ FIND, Geneva, Switzerland.
¹² Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania.

PMID: 39574838
PMCID: PMC11581095
DOI: 10.1101/2024.11.01.24316570

Update in

Using sputum and tongue swab specimens for in-home point-of-care targeted universal testing for tuberculosis of household contacts: an acceptability and feasibility analysis.
Bezuidenhout C, Long L, Nichols B, Meyer-Rath G, Fox MP, Olifant S, Theron G, Fiphaza K, Pieruccini M, Ruhwald M, Penn-Nicholson A, Fourie B, Medina-Marino A. Bezuidenhout C, et al. BMJ Glob Health. 2025 Aug 21;10(8):e018131. doi: 10.1136/bmjgh-2024-018131. BMJ Glob Health. 2025. PMID: 40840972 Free PMC article.

Abstract

Introduction: Effective strategies are needed to facilitate early detection and diagnosis of tuberculosis (TB). The overreliance on passive case detection, symptom screening, and collection of sputum, results in delayed or undiagnosed TB, which directly contributes to on-going TB transmission. We assessed the acceptability and feasibility of in-home, Targeted Universal TB Testing (TUTT) of household contacts using GeneXpert MTB/RIF Ultra at point-of-care (POC) during household contact investigations (HCIs) and compared the feasibility of using sputum vs. tongue swab specimens.

Methods: Household contacts (HHCs) receiving in-home POC TUTT as part of the TB Home Study were asked to complete a post-test acceptability survey. The survey explored HHC's level of comfort, confidence in the test results, and the perceived appropriateness of in-home POC TUTT. We used the Metrics to Assess the Feasibility of Rapid Point-of-Care Technologies framework to assess the feasibility of using sputum and tongue swab specimens for in-home POC TUTT. Descriptive statistics were used to report participant responses and feasibility metrics.

Results: Of 313 eligible HHCs, 267/313 (85.3%) consented to in-home POC TUTT. Of those, 267/267 (100%) provided a tongue swab and 46/267 (17.2%) could expectorate sputum. All specimens were successfully prepared for immediate, in-home testing with Xpert Ultra on GeneXpert Edge. Of 164 tongue swab tests conducted, 160/164 (97.6%) generated a valid test result compared to 44/46 (95.7%) sputum-based tests. An immediate test result was available for 262/267 (98.1%) individuals based on in-home swab testing, and 44/46 (95.7%) based on in-home sputum testing. The mean in-home POC TUTT acceptability score (5=highly acceptable) was 4.5/5 (SD= 0.2).

Conclusion: In-home, POC TUTT using either sputum or tongue swab specimens was highly acceptable and feasible. Tongue swab specimens greatly increase the proportion of HHCs tested compared to sputum. In-home POC TUTT using a combination of sputum and tongue swabs can mitigate shortcomings to case detection.

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References

1. WHO consolidated guidelines on tuberculosis. Module 3: diagnosis - rapid diagnostics for tuberculosis detection, 2021 update. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO - PubMed
1. Thompson RR, Nalugwa T, Oyuku D, Tucker A, Nantale M, Nakaweesa A, et al. Multicomponent strategy with decentralised molecular testing for tuberculosis in Uganda: a cost and cost-effectiveness analysis. The Lancet Global Health. 2023. Feb 1;11(2):e278–86. - PMC - PubMed
1. Global tuberculosis report 2023. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO
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This is a preprint.

USING SPUTUM AND TONGUE SWAB SPECIMENS FOR IN-HOME POINT-OF-CARE TARGETED UNIVERSAL TESTING FOR TB OF HOUSEHOLD CONTACTS: AN ACCEPTABILITY AND FEASIBILITY ANALYSIS

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USING SPUTUM AND TONGUE SWAB SPECIMENS FOR IN-HOME POINT-OF-CARE TARGETED UNIVERSAL TESTING FOR TB OF HOUSEHOLD CONTACTS: AN ACCEPTABILITY AND FEASIBILITY ANALYSIS

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