Our history of active case finding for TB
Detecting cases in the community is restricted by the lack of sensitive and user-friendly point-of-care (POC) diagnostic tools. To address this unmet need, in 2013 the UCT Lung Institute planned a programme of activities (sequential interlinked studies) with the overarching aim of optimising a model for Xpert-related community-based active case finding (ACF) for TB.
By 2017, through the EDCTP-funded XACT I study, we solved the impasse of rapid POC diagnosis by showing that molecular Xpert-based community-based screening was effective in identifying missing TB cases in the peri-urban ‘slums’ of Cape Town and Harare using a mini-truck with a generator.
However, such an approach was neither broadly affordable nor scalable. We therefore derived a scalable model using portable battery-operated Xpert Edge installed within low-cost (< US$ 15 000) Nissan panel van manned by two health care workers (thus making the ACF model affordable and scalable). This completed study, XACT II, screened over 5 000 participants in the community. The model worked well and was more effective than smear microscopy.
Based on these successes, and to translate the XACT concept into policy, the Wellcome Trust and UK MRC has funded the XACT III study. Currently commenced, XACT III was initiated as a multi-country demonstration project in four sub-Saharan African countries.
https://www.xact3.co.za/https://clinicaltrials.gov/ct2/show/NCT04303104