Decline in prevalence of tuberculosis following an intensive case-finding campaign and the COVID-19 pandemic in an urban Ugandan community

Abstract Background Systematic screening is a potential tool for reducing the prevalence of tuberculosis and counteracting COVID-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of tuberculosis over time. Methods We conducted serial, cross-sectional tuberculosis case-finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum for tuberculosis testing (Xpert MTB/RIF Ultra) from all adolescents and adults. We estimated the prevalence of tuberculosis among screening participants in each campaign and compared characteristics of people with tuberculosis across campaigns. We simultaneously enrolled and characterized community residents who were diagnosed with tuberculosis through routine care and assessed trends in facility-based diagnosis. Results We successfully screened 12,033 community residents (35% of the estimated adult/adolescent population) in 2019 and 11,595 (33%) in 2021. In 2019, 0.94% (95% CI 0.77-1.13%) of participants tested Xpert-positive (including trace). This proportion fell to 0.52% (95%CI 0.40-0.67%) in 2021; the prevalence ratio was 0.55 [95%CI: 0.40-0.75]). There was no change in the age (median 26 vs 26), sex (56% vs 59% female), or prevalence of chronic cough (49% vs 54%) among those testing positive. By contrast, the rate of routine facility-based diagnosis remained steady in the eight months before each campaign (210 [95%CI 155-279] vs. 240 [95%CI 181-312] per 100,000 per year). Conclusions Following an intensive initial case-finding campaign in an urban Ugandan community in 2019, the burden of prevalent tuberculosis as measured by systematic screening had decreased by 45% in 2021, despite the intervening COVID-19 pandemic.