Rapid Research in Diagnostics Development for TB Network (R2D2 TB Network) Study
To reduce the burden of TB worldwide through more accurate, faster, simpler, and less expensive diagnosis of TB Every year, more than 3 million people with TB remain undiagnosed and 1 million die. Better diagnostics are essential to reducing the enormous burden of TB worldwide. The Rapid Research in Diagnostics Development for TB Network (R2D2 TB Network) brings together experts in TB care, technology assessment, diagnostics development, laboratory medicine, epidemiology, health economics and mathematical modeling with highly experienced clinical study sites in 10 countries.
⁃ Novel TB triage and diagnostic tests:
⁃ We will include non-hospitalized adults (age ≥ 12 years) with either 1) cough ≥2 weeks' duration, a commonly accepted criterion for identifying people with presumed pulmonary TB (to facilitate standardization across sites and comparison of test performance across sub-groups or 2) risk factors for which TB screening is recommended (HIV infection, self-reported close contact, history of mining work). People with risk factors will be included if they screen positive for TB based on WHO-recommended screening tools as specified below:
⁃ Positive TB screening definitions by risk factor:
• PLHIV (Risk Factor), CRP \>5 mg/dL OR abnormal CXR (Positive TB screening definition)
• Self-reported Close Contact (Risk Factor), abnormal CXR (Positive TB screening definition)
• History of mining work (Risk Factor), abnormal CXR (Positive TB screening definition)
⁃ We will exclude people who:
• completed latent or active TB treatment within the past 12 months (to increase TB prevalence and reduce false-positive results, respectively);
• have taken any medication with anti-mycobacterial activity (including fluoroquinolones) for any reason, within 2 weeks of study entry (to reduce false-negatives);
• reside \>20km from the study site or are unwilling to return for follow-up visits; or
• are unwilling to provide informed consent
⁃ Novel TB rDST assays:
⁃ We will include adults (age ≥12 years) who are positive for TB and RIF resistance according to routine diagnostic testing (based typically on Xpert MTB/RIF, Xpert MTB/RIF Ultra, or Hain MTBDRplus). We will exclude people who:
• have negative or contaminated results on all baseline (i.e., enrollment) sputum cultures
• are unable to provide at least two sputum specimens of 3 mL each within one day of enrollment
• are unable or unwilling to provide informed consent
⁃ Assessment of the usability of novel TB tests:
⁃ We will include health workers at each clinical site who are 1) aged ≥18 years and 2) involved in routine TB testing (collecting specimens for or performing TB tests). We will exclude staff who are unwilling to provide informed consent.