Active Infection & Immunity Diabetes, Hormones & Metabolism

Asymptomatic TB Transmission in Indonesia and South Africa (ATTIS Study)

In plain English

AI plain-English summary

People with tuberculosis who show no symptoms may be silently spreading the infection to those around them. This study will measure just how infectious these asymptomatic individuals are, compared to both symptomatic TB patients and the general background transmission in communities. The problem is a critical blind spot in TB control. Current screening and treatment efforts focus on people who cough, but prevalence surveys consistently find many people with bacteriologically-confirmed TB who feel perfectly well. Without knowing their contribution to transmission, public health strategies may be missing a major driver of the epidemic. If this research succeeds, it could reshape how countries screen for TB and who they prioritise for treatment. The findings are intended to inform World Health Organization and national policy on scalable screening approaches, reporting, and management of asymptomatic TB. This could lead to more effective, targeted interventions that interrupt transmission chains before symptoms ever appear—quietly improving the infrastructure of global TB control without most people ever noticing.

View original technical description
There is strong evidence from prevalence surveys that many persons with bacteriologically-confirmed TB are asymptomatic. Key unresolved questions are: how infectious are people with asymptomatic TB (aSxTB) and what is their contribution to global Mtb transmission.The primary objectives of this study is to compare household Mtb transmission from people with bacteriologically- confirmed aSxTB with background community transmission of Mtb; and also with bacteriologically-confirmed symptomaticTB (sxTB). Secondary objectives include to evaluate the diagnostic performance of current and novel diagnostic tools for aSxTB; to characterize the features and longitudinal outcomes of sub- groups of people with aSxTB; and to model the contributions of aSxTB to global TB incidence. Project will be conducted in Indonesia and South Africa. We will conduct large-scale (N= 60,000 in Indonesia, N=25,000 in South Africa) community screening of adults (>15 years of age) who reside in households with children to identify index individuals with aSxTB and SxTB. The infectiousness of people with TB will be estimated based on the proportion of child (aged 2-14 years) household contacts who have a positive interferon gamma release assay (IGRA) result. This study will provide data for WHO and countries’ policy and guideline development on scalable screening approaches, reporting and management of aSxTB.

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Researchers

Bachti Alisjahbana (EPMC Awardee)Emily Wong (EPMC Awardee)Limakatso Lebina (EPMC Awardee)

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Discretionary Award

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