Active search for tuberculosis in three youth detention centers in Peru.

Abstract

Motivation for the study. With tuberculosis being the leading cause of death due to infectious diseases in the world, and having a detection gap of 20-40%, there is a need to implement active search strategies for the disease in different vulnerable populations such as juvenile correctional facilities. Main findings. We found a screening rate by active search of 1250 per 100,000 screened, being 10 times more than the rate in the general population. Seventy-five percent of GeneXpert-positive cases were asymptomatic. Implications. By using innovative TB screening mechanisms and algorithms, cases can be identified early, which favors treatment prognosis, as well as reducing the chain of disease transmission. This study aimed to describe the rate of tuberculosis (TB) found by using the active search strategy in teenagers and youths in three youth detention centers. TB was screened through the active search algorithm with chest X-ray, the automated reading was carried out by artificial intelligence software, the GeneXpert Ultra MTB/RIF molecular test, and clinical evaluation. A total of 640 individuals were screened, 94 (14.6%) had an abnormal chest X-ray. Of those screened, we obtained 105 GeneXpert tests of which 94 had abnormal X-rays, 9 were respiratory symptomatic and 2 were on antiretroviral treatment with TB clinical picture. We obtained 8 (8.5%) cases of TB detected with GeneXpert, 7 with abnormal radiography and 1 with normal radiography. Finally, of these 8 cases, 3 were cases of rifampicin-resistant tuberculosis (RR-TB) (42.8%). The rate of screening by active search was 1250 per 100,000 screened, 10 times higher than the rate in the general population. We recommend the inclusion of youth detention centers as target groups for systematic screening and the development of interventions to reduce the risk of TB infection.