DOI: 10.5061/dryad.905qfttnq
title: Policy and programmatic directions for the Lesotho tuberculosis programme: Findings of the national tuberculosis prevalence survey, 2019

description: Introduction The Kingdom of Lesotho has one of the highest burdens of
 tuberculosis (TB) in the world. A national TB prevalence survey was
 conducted to estimate the prevalence of bacteriologically confirmed
 pulmonary TB disease among those ≥15 years of age in 2019. Method A
 multistage cluster-based cross-sectional survey where residents ≥15 years
 in 54 clusters sampled from across the country were eligible to
 participate. Survey participants were screened using a symptom screen
 questionnaire and digital chest X-ray (CXR). Respondents who acknowledged
 cough of any duration, fever, weight loss, night sweats and/or had any CXR
 abnormality in the lungs were asked to provide two spot sputum specimens.
 All sputum testing was conducted at the National TB Reference Laboratory
 (NTRL), where samples underwent Xpert MTB/RIF Ultra (1st sample) and MGIT
 culture (2nd sample). HIV counselling and testing was offered to all
 survey participants. TB cases were those with Mycobacterium tuberculosis
 complex-positive samples with culture; and where culture was not positive,
 Xpert MTB/RIF Ultra (Xpert Ultra) was positive with a CXR suggestive of
 active TB and no current or prior history of TB. Result A total of 39,902
 individuals were enumerated, and of these, 26,857 (67.3%) were eligible to
 participate; 21,719 (80.9%) participated in the survey of which 8,599
 (40%) were males and 13,120 (60%) were females. All 21,719 (100%) survey
 participants underwent symptom screening and a total of 21,344
 participants (98.3%) had a CXR. Of the 7,584 (34.9%) participants who were
 eligible for sputum examination, 4,190 (55.2%) were eligible by CXR only,
 1,455 (19.2%) by symptom screening, 1,630 by both, and 309 by CXR
 exemption. A total of 6,780 (89.4%) submitted two sputum specimens, and
 311 (4.1%) submitted one sample only. From the 21,719 survey participants,
 HIV counseling and testing was offered to 17,048, and 3,915 (23.0%) were
 documented as HIV-positive. The survey identified 132 participants with
 bacteriologically confirmed pulmonary TB thus providing an estimated
 prevalence of 581 per 100,000 population (95% CI 466–696) for those ≥15
 years in 2019. Using the survey results, TB incidence was re-estimated to
 be 654 per 100,000 (95% CI 406–959), which was comparable to the 2018 TB
 incidence rate of 611 per 100,000 (95% CI 395–872) reported by the World
 Health Organization (WHO). The highest TB burden was found in those ≥55
 years and among men. The ratio of prevalence to case notification was
 estimated at 1.22. TB/HIV coinfection was identified in 39 (29.6%)
 participants. Out of the 1,825 participants who reported a cough, 50% of
 these participants, mostly men, did not seek care. Those who sought care
 predominantly went to the public health facilities. Conclusion The TB
 prevalence survey results confirmed that burden of TB and TB/HIV
 coinfection remains very high in Lesotho. Given that TB prevalence remains
 high, and there is a significant proportion of participants with confirmed
 TB that did not report TB suggestive symptoms. The National TB Programme
 will need to update its TB screening and treatment algorithms to achieve
 the End TB targets. A major focus will need to be placed on finding the
 “missing cases” i.e., undiagnosed or under-reported TB cases, or ensuring
 that not only TB symptomatic but also those who do not present with
 typical TB symptoms are promptly identified to reduce further onward
 transmission.
description: <strong>Method</strong>: A multistage cluster-based
 cross-sectional survey where residents ≥15 years in 54 clusters sampled
 from across the country were eligible to participate. Survey participants
 were screened using a symptom screen questionnaire and digital chest X-ray
 (CXR). Respondents who acknowledged cough of any duration, fever, weight
 loss, night sweats and/or had any CXR abnormality in the lungs were asked
 to provide two spot sputum specimens. All sputum testing was conducted at
 the National TB Reference Laboratory (NTRL), where samples underwent Xpert
 MTB/RIF Ultra (1st sample) and MGIT culture (2nd sample). HIV counselling
 and testing were offered to all survey participants. TB cases were those
 with <em>Mycobacterium tuberculosis</em> complex-positive
 samples with culture; and where culture was not positive, Xpert MTB/RIF
 Ultra (Xpert Ultra) was positive with a CXR suggestive of active TB and no
 current or prior history of TB.
 <strong>Result</strong>: A total of 39,902
 individuals were enumerated, and of these, 26,857 (67.3%) were eligible to
 participate; 21,719 (80.9%) participated in the survey of which 8,599
 (40%) were males and 13,120 (60%) were females. All 21,719 (100%) survey
 participants underwent symptom screening and a total of 21,344
 participants (98.3%) had a CXR. Of the 7,584 (34.9%) participants who were
 eligible for sputum examination, 4,190 (55.2%) were eligible by CXR only,
 1,455 (19.2%) by symptom screening, 1,630 by both, and 309 by CXR
 exemption. A total of 6,780 (89.4%) submitted two sputum specimens, and
 311 (4.1%) submitted one sample only. From the 21,719 survey participants,
 HIV counseling and testing were offered to 17,048, and 3,915 (23.0%) were
 documented as HIV-positive. The survey identified 132 participants with
 bacteriologically confirmed pulmonary TB thus providing an estimated
 prevalence of 581 per 100,000 population (95% CI 466–696) for those ≥15
 years in 2019. Using the survey results, TB incidence was re-estimated to
 be 654 per 100,000 (95% CI 406–959), which was comparable to the 2018 TB
 incidence rate of 611 per 100,000 (95% CI 395–872) reported by the World
 Health Organization (WHO). The highest TB burden was found in those ≥55
 years and among men. The ratio of prevalence to case notification was
 estimated at 1.22. TB/HIV coinfection was identified in 39 (29.6%)
 participants. Out of the 1,825 participants who reported a cough, 50% of
 these participants, mostly men, did not seek care. Those who sought care
 predominantly went to public health facilities.
description: Stata