# Hotspot versus clinic-based active case finding for TB in Uganda: A pragmatic randomized trial

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $560,353

## Abstract

Project Summary
Tuberculosis (TB) is a leading cause of global morbidity and mortality; every year, nearly three million people
develop TB disease but are never notified to public health authorities. Studies in Vietnam and Zimbabwe have
shown that intensive efforts to find individuals with undiagnosed TB (“active case finding”, ACF) can greatly
reduce TB burden. However, in high-burden countries, repeated population-level ACF is not a viable strategy.
Therefore, it is critical to understand whether ACF can be implemented in a manner that is both economically/
logistically feasible and epidemiologically impactful. Additionally, as an estimated 23% of the world's population
is infected with M. tuberculosis, it is increasingly clear that global targets to end TB cannot be achieved without
scaling up TB preventive therapy (TPT). Since ruling out TB disease is essential before providing TPT, ACF
offers a unique opportunity to expand TPT by screening a broader population for TB disease; however, most
previous ACF campaigns in high-burden countries have not included linkage to TPT. Key recent technological
innovations, including mobile chest X-ray devices, AI-based X-ray reading, and novel short-course TPT
regimens, have made mass ACF with linkage to TPT feasible for the first time, with potential for transformative
impact on TB burden. In our initial R01 study (STOMP-TB), we identified venue-based screening (VBS) as an
efficient approach to ACF in an urban Ugandan community; nearly 3% of VBS attendees had undiagnosed TB
disease. In this renewal project, we will rigorously evaluate the comparative effectiveness and implementation
of two approaches to venue-based ACF with linkage to TPT, each building on specific findings from STOMP-
TB. Specifically, we will conduct a multiple period, cluster randomized crossover trial (type 1 hybrid
effectiveness-implementation design) comparing a health facility-based approach to ACF/TPT that
incorporates existing infrastructure and patients' expressed preferences and a “hotspot”-based approach that
brings testing directly to neighborhoods experiencing the highest burden of TB. In Aim 1, we will compare the
effectiveness of hotspot-focused versus facility-based ACF/TPT in eight regions near Kampala, Uganda. Our
primary outcome will be the number of individuals initiating treatment for confirmed pulmonary TB. Secondary
analyses will include the number of people linked to TPT and notifications in the eight intervention regions
compared to four control regions. In Aim 2, we will compare implementation (reach, implementation, and
maintenance) and incremental cost-effectiveness of hotspot-focused versus facility-based ACF/TPT. In Aim 3,
we will use modeling and simulation to estimate intervention effects on the proportion of cases diagnosed, time
to TB diagnosis, and projected 10-year TB incidence and mortality. This study will provide randomized yet
pragmatic evidence to support the implementation and effectiveness of fea...

## Key facts

- **NIH application ID:** 10745982
- **Project number:** 5R01HL138728-07
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** David Wesley Dowdy
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $560,353
- **Award type:** 5
- **Project period:** 2017-08-15 → 2026-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10745982

## Citation

> US National Institutes of Health, RePORTER application 10745982, Hotspot versus clinic-based active case finding for TB in Uganda: A pragmatic randomized trial (5R01HL138728-07). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10745982. Licensed CC0.

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