{ "abstract": "Background\n\nActive case finding (ACF) for tuberculosis (TB) can reduce transmission, yet efficient targeting requires high-quality surveillance data. We investigated the potential costs and impact of targeted ACF, guided by local estimates of the annual risk of TB infection (ARTI) derived from Mycobacterium tuberculosis (Mtb) immunoreactivity survey data in children aged <5 years.Methods and findings\n\nUsing mathematical models parameterized with local data, we compared three case-finding approaches across 33 urban neighborhoods in Blantyre, Malawi: passive case finding (PCF) only; PCF with untargeted ACF; and PCF with ARTI-guided targeted ACF. Health outcomes (life expectancy, disability-adjusted life years [DALYs]) and costs were estimated using a Markov microsimulation model. Costs were assessed from health system and societal perspectives. Results were calculated for different assumptions about the relationship between ARTI and true TB prevalence. Compared to PCF-only, untargeted ACF was estimated to improve life expectancy by 3.3 years (95% credible interval (CrI) [1.7, 5.4]) for individuals with TB disease, but at high cost. Targeted ACF covering half of the study population was estimated to identify 80% of all individuals with TB and achieved a lower cost per DALY averted (US$400, 95% CrI [20,1,000]) than untargeted ACF (US$700, 95% CrI [100, 1,500]). In the main analysis, these cost-effectiveness ratios exceeded available cost-effectiveness thresholds for Malawi, although cost-effectiveness improved under assumptions of higher TB prevalence or greater transmission reduction. The findings are based on mathematical modeling and are subject to several limitations, including assumptions regarding the relationship between ARTI and TB prevalence, which remains uncertain.Conclusions\n\nTargeting ACF using Mtb immunoreactivity survey data could substantially improve health impact and cost-effectiveness compared to untargeted approaches. However, low-cost approaches for collecting these data are needed for wider adoption.", "abstract_shown": true, "affiliations": [ "Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.", "Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.", "Malawi Liverpool Wellcome Programme, Blantyre, Malawi.", "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.", "Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi.", "National Tuberculosis and Leprosy Elimination Program, Ministry of Health, Lilongwe, Malawi.", "School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom.", "Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America." ], "article_type": "Research Article", "arxiv": null, "author_total": 13, "authors": [ { "affs": [ 0 ], "name": "Sun Kim", "orcid": "0000-0002-2466-2442" }, { "affs": [ 0 ], "name": "Melike Hazal Can", "orcid": "0000-0001-6810-0356" }, { "affs": [ 1, 2 ], "name": "Hannah M Rickman", "orcid": "0000-0002-3502-0744" }, { "affs": [ 2, 3 ], "name": "Mphatso D Phiri", "orcid": "0000-0002-4072-9715" }, { "affs": [ 4 ], "name": "Marriott Nliwasa", "orcid": "0000-0002-3100-5512" }, { "affs": [ 5 ], "name": "Tisungane E Mwenyenkulu" }, { "affs": [ 5 ], "name": "Kuzani Mbendera" }, { "affs": [ 0 ], "name": "Stéphane Verguet", "orcid": "0000-0003-4128-0849" }, { "affs": [ 0 ], "name": "Marcia C Castro", "orcid": "0000-0003-4606-2795" }, { "affs": [ 1, 2 ], "name": "Elizabeth L Corbett", "orcid": "0000-0002-3552-3181" }, { "affs": [ 6 ], "name": "Peter MacPherson", "orcid": "0000-0002-0329-9613" }, { "affs": [ 7 ], "name": "Ted Cohen", "orcid": "0000-0002-8091-7198" }, { "affs": [ 0 ], "name": "Nicolas A Menzies", "orcid": "0000-0002-2571-016X" } ], "bibtex": "https://research.draconitic.com/paper/1bb8a48hgmt4x.bib", "cited_by": 0, "doi": "10.1371/journal.pmed.1005272", "fulltext_url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005272", "id": "1bb8a48hgmt4x", "issns": [ "1549-1676", "1549-1277" ], "landing_url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005272", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2725|Tuberculosis Research and Epidemiology" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Bacteria/Actinobacteria/Mycobacterium tuberculosis" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Population biology/Population metrics/Life expectancy" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Tuberculosis diagnosis and management" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases/Tuberculosis" ], [ "plos", "/Medicine and health sciences/Medical conditions/Tropical diseases/Tuberculosis" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Life expectancy" ], [ "plos", "/People and places/Geographical locations/Africa/Malawi" ], [ "plos", "/Social sciences/Economics/Economic analysis/Cost-effectiveness analysis" ] ], "openalex": "W7220833682", "pdf_url": "https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1005272&type=printable", "pmcid": "PMC13657404", "pmid": "42842627", "published": "2026-10-07", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/1bb8a48hgmt4x.ris", "sources": [ { "first_seen": "2026-10-30T12:17:30Z", "native_id": "10.1371/journal.pmed.1005272", "source": "plos", "url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005272" }, { "first_seen": "2026-10-30T12:18:02Z", "native_id": "MED:42842627", "source": "europepmc", "url": "https://europepmc.org/article/MED/42842627" } ], "subjects": [ { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:infectious diseases", "subfield": "infectious-disease" } ], "title": "Potential health impacts and costs of active case finding guided by Mycobacterium tuberculosis immunoreactivity survey results in Blantyre, Malawi: A mathematical modeling study", "title_text": "Potential health impacts and costs of active case finding guided by Mycobacterium tuberculosis immunoreactivity survey results in Blantyre, Malawi: A mathematical modeling study", "type": "peer-reviewed", "updated_at": "2026-10-30T12:18:02Z", "url": "https://research.draconitic.com/paper/1bb8a48hgmt4x", "venue": "PLOS Medicine", "versions": [] }