03111nas a2200361   4500000000100000008004100001260001200042653001700054653001700071653002200088653002400110653001800134653001700152100001400169700001100183700001300194700001800207700001500225700001200240700001300252700001500265700001800280700001000298700001200308700001400320700001300334245013500347856007800482300001200560490000700572520215600579022001402735       2022                            d  c04/202210aEpidemiology10aEpidemiology10aInfection Control10aPreventive Medicine10aPublic health10aTuberculosis1 aColeman M1 aHill J1 aTimeon E1 aTonganibeia A1 aEromanga B1 aIslam T1 aTrauer J1 aChambers S1 aChristensen A1 aFox G1 aMarks G1 aBritton W1 aMarais B00aPopulation-wide active case finding and prevention for tuberculosis and leprosy elimination in Kiribati: the PEARL study protocol.  uhttps://bmjopen.bmj.com/content/bmjopen/12/4/e055295.full.pdf?with-ds=yes  ae0552950 v123 a<p><strong>INTRODUCTION: </strong>Population-wide interventions offer a pathway to tuberculosis (TB) and leprosy elimination, but 'real-world' implementation in a high-burden setting using a combined approach has not been demonstrated. This implementation study aims to demonstrate the feasibility and evaluate the effect of population-wide screening, treatment and prevention on TB and leprosy incidence rates, as well as TB transmission.</p>

<p><strong>METHODS AND ANALYSIS: </strong>A non-randomised 'screen-and-treat' intervention conducted in the Pacific atoll of South Tarawa, Kiribati. Households are enumerated and all residents ≥3 years, as well as children &lt;3 years with recent household exposure to TB or leprosy, invited for screening. Participants are screened using tuberculin skin testing, signs and symptoms of TB or leprosy, digital chest X-ray with computer-aided detection and sputum testing (Xpert MTB/RIF Ultra). Those diagnosed with disease are referred to the National TB and Leprosy Programme for management. Participants with TB infection are offered TB preventive treatment and those without TB disease or infection, or leprosy, are offered leprosy prophylaxis. The primary study outcome is the difference in the annual TB case notification rate before and after the intervention; a similar outcome is included for leprosy. The effect on TB transmission will be measured by comparing the estimated annual risk of TB infection in primary school children before and after the intervention, as a co-primary outcome used for power calculations. Comparison of TB and leprosy case notification rates in South Tarawa (the intervention group) and the rest of Kiribati (the control group) before, during and after the intervention is a secondary outcome.</p>

<p><strong>ETHICS AND DISSEMINATION: </strong>Approval was obtained from the University of Sydney Human Research Ethics Committee (project no. 2021/127) and the Kiribati Ministry of Health and Medical Services (MHMS). Findings will be shared with the MHMS and local communities, published in peer-reviewed journals and presented at international conferences.</p>
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